MEDICARE: CASSIE HARRISON

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
1	363LF0000X	Family Nurse Practitioner	11018166	FL

General Provider Information

NPI Number	:	1710629852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE HARRISON

Provider Business Mailing Address
First Line	:	5327 PLANTATION HOME WAY
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-7528
Country	:	US
Telephone Number	:	386-561-9026
Fax Number	:	828-800-9933

Provider Business Practice Location Address
First Line	:	1402 DUNLAWTON AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2917
Country	:	US
Telephone Number	:	386-561-9026
Fax Number	:	828-800-9933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2022
Last Update Date	:	03/24/2026

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Directions to “ CASSIE HARRISON ” Practice Location

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