Healthcare Provider Details

I. General information

NPI: 1356690721
Provider Name (Legal Business Name): CHERYL ANDERSON CASKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 EAST MAIN STREET
LAKE BUTLER FL
32054
US

IV. Provider business mailing address

6304 CARRANZA DRIVE
JACKSONVILLE FL
32216-4408
US

V. Phone/Fax

Practice location:
  • Phone: 386-496-2323
  • Fax:
Mailing address:
  • Phone: 904-501-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9192976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: