Healthcare Provider Details

I. General information

NPI: 1104815570
Provider Name (Legal Business Name): CASSANDRA L GARCIA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 N. MILITARY TRAIL, SUITE 508
PALM BEACH GARDENS FL
33410
US

IV. Provider business mailing address

8645 N. MILITARY TRAIL, SUITE 508
PALM BEACH GARDENS FL
33410
US

V. Phone/Fax

Practice location:
  • Phone: 561-630-8001
  • Fax: 561-630-8007
Mailing address:
  • Phone: 561-630-8001
  • Fax: 561-630-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1691172
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1691172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: