Healthcare Provider Details

I. General information

NPI: 1205671203
Provider Name (Legal Business Name): KASSIDY COMBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

3725 JOHN ANDERSON DR
ORMOND BEACH FL
32176-8924
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11047842
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9565385
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: