Healthcare Provider Details

I. General information

NPI: 1124820022
Provider Name (Legal Business Name): CASSANDRA CALERO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 SALISBURY RD
JACKSONVILLE FL
32256-0902
US

IV. Provider business mailing address

4655 SALISBURY RD
JACKSONVILLE FL
32256-0902
US

V. Phone/Fax

Practice location:
  • Phone: 904-570-9404
  • Fax:
Mailing address:
  • Phone: 904-570-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11037691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: