Provider Demographics
NPI:1124787742
Name:WARNER, CASSANDRA NICHOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:NICHOLE
Last Name:WARNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:CASSANDRA
Other - Middle Name:NICHOLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:4090 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4501
Practice Address - Country:US
Practice Address - Phone:386-761-0050
Practice Address - Fax:386-761-1167
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily