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NPI Code Detail

MEDICARE: KASSIDY DIETER APRN

MEDICARE: KASSIDY DIETER APRN
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
1363L00000XNurse PractitionerAPRN11044026FL

General Provider Information

NPI Number : 1659237683
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASSIDY DIETER APRN
Provider Business Mailing Address
First Line : 2122 UNIVERSITY BLVD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8937
Country : US
Telephone Number : 904-398-5614
Fax Number :
Provider Business Practice Location Address
First Line : 2122 UNIVERSITY BLVD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8937
Country : US
Telephone Number : 904-398-5614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2026
Last Update Date : 01/03/2026

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Directions to “ KASSIDY DIETER APRN” Practice Location

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