Healthcare Provider Details

I. General information

NPI: 1508644717
Provider Name (Legal Business Name): CASSANDRA THORLA CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13275 W COLONIAL DR
WINTER GARDEN FL
34787-3984
US

IV. Provider business mailing address

110 S WOODLAND ST
WINTER GARDEN FL
34787-3546
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8827
  • Fax: 321-221-9454
Mailing address:
  • Phone: 407-905-8827
  • Fax: 321-221-9454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0024188068
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11041262
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: