Healthcare Provider Details

I. General information

NPI: 1275481384
Provider Name (Legal Business Name): CASSIDY BLANK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6827 1ST AVE S STE 100
ST PETERSBURG FL
33707-1242
US

IV. Provider business mailing address

6827 1ST AVE S STE 100
ST PETERSBURG FL
33707-1242
US

V. Phone/Fax

Practice location:
  • Phone: 727-341-0551
  • Fax: 727-341-0332
Mailing address:
  • Phone: 727-341-0551
  • Fax: 727-341-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9121727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: