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General NPI Number Information
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NPI Number | 1184203721
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Entity Type | Organization
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Legal Business Name | CASSIDY HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 310 S MARION AVE
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City | LAKE CITY
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State | FL
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Zip | 32025-7064
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Country | US
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Telephone | 386-438-5722
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Fax | 386-438-8631
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Provider Business Mailing Address
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Address Line | 263 SW PROFESSIONAL GLN
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City | LAKE CITY
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State | FL
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Zip | 32025-1105
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Country | US
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Telephone | 386-438-5722
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Fax | 386-438-8631
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY P CASSIDY JR.
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Credential |
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Telephone | 386-438-5722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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