Healthcare Provider Details

I. General information

NPI: 1518730142
Provider Name (Legal Business Name): CASSANDRA JENNINGS LMT, LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 GAZEBO PARK PL S STE 101
JACKSONVILLE FL
32257-1086
US

IV. Provider business mailing address

6144 GAZEBO PARK PL S STE 101
JACKSONVILLE FL
32257-1086
US

V. Phone/Fax

Practice location:
  • Phone: 904-260-3011
  • Fax:
Mailing address:
  • Phone: 904-260-3011
  • Fax: 904-260-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN1278991
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA54006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: