Healthcare Provider Details

I. General information

NPI: 1346701406
Provider Name (Legal Business Name): CASIE MCCALLISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 S YONGE ST STE 3A
ORMOND BEACH FL
32174-7501
US

IV. Provider business mailing address

454 S YONGE ST STE 3A
ORMOND BEACH FL
32174-7501
US

V. Phone/Fax

Practice location:
  • Phone: 386-280-4877
  • Fax: 386-414-7227
Mailing address:
  • Phone: 386-280-4877
  • Fax: 386-414-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001968
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11001968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: