Healthcare Provider Details

I. General information

NPI: 1871013441
Provider Name (Legal Business Name): DOROTHY DIANNE CASH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 BRICKYARD RD
CHIPLEY FL
32428-6303
US

IV. Provider business mailing address

805 ROCK HILL CHURCH RD
COTTONDALE FL
32431-8809
US

V. Phone/Fax

Practice location:
  • Phone: 850-638-1610
  • Fax:
Mailing address:
  • Phone: 850-326-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9218489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: