Healthcare Provider Details

I. General information

NPI: 1023347259
Provider Name (Legal Business Name): CARLA ANN CASSIDY RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N.W. TURNER AVE.
LAKE CITY FL
32055
US

IV. Provider business mailing address

320 N.W. TURNER AVE.
LAKE CITY FL
32055
US

V. Phone/Fax

Practice location:
  • Phone: 386-754-1711
  • Fax: 386-754-1712
Mailing address:
  • Phone: 386-754-1711
  • Fax: 386-754-1712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT6915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: