Healthcare Provider Details

I. General information

NPI: 1225318256
Provider Name (Legal Business Name): CASSIA JAVANICA HOUSE CALLS AND TELE-MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 SW 14TH AVE
OCALA FL
34476-7639
US

IV. Provider business mailing address

8931 SW 14TH AVE
OCALA FL
34476-7639
US

V. Phone/Fax

Practice location:
  • Phone: 352-350-5012
  • Fax: 866-803-9452
Mailing address:
  • Phone: 352-350-5012
  • Fax: 866-803-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number110410
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number110410
License Number StateFL

VIII. Authorized Official

Name: DR. F PATRICIA MCEACHRANE-GROSS
Title or Position: CEO
Credential: MD, MPH
Phone: 352-857-7524