Provider Demographics
NPI:1306142518
Name:ABBOTT CATRON, CASSIDY (ARNP)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:ABBOTT CATRON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 BEAL PARKWAY NW
Mailing Address - Street 2:UNIT 1023 SUITE A
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-450-2519
Mailing Address - Fax:
Practice Address - Street 1:913 BEAL PARKWAY NW
Practice Address - Street 2:UNIT 1023 SUITE A
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-450-2519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM73096363LF0000X
FL9395621363LF0000X
FLARNP9395621363LF0000X
TX1170865363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014798500Medicaid
FLY0Q0ROtherFLORIDA BLUE
FL1436762OtherWELLCARE
FL5151920OtherAETNA