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General NPI Number Information
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NPI Number | 1710629852
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Entity Type | Individual
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Provider Name | CASSIE HARRISON
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Gender | Female
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Dates
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Enumeration Date | 04/09/2022
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1200 FLORAL SPRINGS BLVD UNIT 12203
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City | PORT ORANGE
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State | FL
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Zip | 32129-6812
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Country | US
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Telephone | 321-544-8558
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Fax |
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Provider Business Mailing Address
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Address Line | 5327 PLANTATION HOME WAY
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City | PORT ORANGE
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State | FL
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Zip | 32128-7528
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Country | US
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Telephone | 321-544-8558
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11018166
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License Number State | FL
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