Provider Demographics
NPI:1699251652
Name:PATULA, CASSANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:PATULA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:MENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1885 SHORE DR S APT 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4736
Mailing Address - Country:US
Mailing Address - Phone:847-393-3514
Mailing Address - Fax:
Practice Address - Street 1:929 S TAMIAMI TRL STE 201
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9241
Practice Address - Country:US
Practice Address - Phone:941-918-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant