Healthcare Provider Details

I. General information

NPI: 1881431799
Provider Name (Legal Business Name): CASSIDY GATEWOOD DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MEMORIAL MEDICAL PKWY
DAYTONA BEACH FL
32117-5167
US

IV. Provider business mailing address

770 W GRANADA BLVD STE 101
ORMOND BEACH FL
32174-5179
US

V. Phone/Fax

Practice location:
  • Phone: 386-231-6000
  • Fax:
Mailing address:
  • Phone: 386-231-4746
  • Fax: 386-368-8927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: