Healthcare Provider Details

I. General information

NPI: 1437468147
Provider Name (Legal Business Name): CATHY CASSUBE UNDERHILL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S MAIN ST
TRENTON FL
32693-3239
US

IV. Provider business mailing address

911 S MAIN ST
TRENTON FL
32693-3239
US

V. Phone/Fax

Practice location:
  • Phone: 352-463-2374
  • Fax: 352-463-4507
Mailing address:
  • Phone: 352-463-2374
  • Fax: 352-463-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2047432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: