Individual
JIMMY PETER CASSIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
404 SE 15TH ST, FORT LAUDERDALE, FL 33316-1942
(954) 530-8638
(954) 530-8638
Mailing address
5841 NE 21ST WAY, FORT LAUDERDALE, FL 33308-2524
(954) 530-8638
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
ARNP 2642392
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
ARNP2642392
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014428800
—
FL
01
—
ID168Z
MEDICARE PTAN
FL
Enumeration date
04/13/2011
Last updated
03/03/2025
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