Provider Demographics
NPI:1063745396
Name:DAVIS, CASSIE MICHELLE (ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 CENTENNIAL BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0588
Mailing Address - Country:US
Mailing Address - Phone:850-877-8539
Mailing Address - Fax:
Practice Address - Street 1:2631 CENTENNIAL BLVD
Practice Address - Street 2:STE 100
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0588
Practice Address - Country:US
Practice Address - Phone:850-877-8539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9178836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001495100Medicaid
FL001495100Medicaid