| Cassidy Health And Wellness Llc | |
|
310 S Marion Ave Lake City FL 32025-7064 | |
| (386) 438-5722 | |
| (386) 438-8631 |
| Full Name | Cassidy Health And Wellness Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 310 S Marion Ave, Lake City, Florida |
| Authorized Official Name and Position | Timothy P Cassidy (OWNER) |
| Authorized Official Contact | 3864385722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cassidy Health And Wellness Llc 263 Sw Professional Gln Lake City FL 32025-1105 Ph: (386) 438-5722 | Cassidy Health And Wellness Llc 310 S Marion Ave Lake City FL 32025-7064 Ph: (386) 438-5722 |
| NPI Number | 1184203721 |
|---|---|
| Provider Enumeration Date | 04/02/2021 |
| Last Update Date | 07/17/2023 |
| Medicare PECOS PAC ID | 5496163230 |
|---|---|
| Medicare Enrollment ID | O20210416000462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184203721 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Todd A Perla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235146408 PECOS PAC ID: 0840229308 Enrollment ID: I20050805000245 |
| Provider Name | Timothy Paul Cassidy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841760816 PECOS PAC ID: 3476890856 Enrollment ID: I20190123001667 |
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