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NPI Code Detail

MEDICARE: CASSIDY BLANK

MEDICARE: CASSIDY BLANK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramFL

General Provider Information

NPI Number : 1275481384
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY BLANK
Provider Business Mailing Address
First Line : 4401 N HIMES AVE STE 175
Second Line :
City : TAMPA
State : FL
Zip : 33614-7095
Country : US
Telephone Number : 813-393-3800
Fax Number :
Provider Business Practice Location Address
First Line : 4401 N HIMES AVE STE 175
Second Line :
City : TAMPA
State : FL
Zip : 33614-7095
Country : US
Telephone Number : 813-393-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/17/2026

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Directions to “ CASSIDY BLANK ” Practice Location

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