Healthcare Provider Details

I. General information

NPI: 1467997437
Provider Name (Legal Business Name): SUSANA CASSAGLIA NP, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSANA CASSAGLIA NP, MD

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 BOULEVARD
JACKSONVILLE FL
32206-4382
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1040
  • Fax:
Mailing address:
  • Phone: 904-383-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22543
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: