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Individual

MR. TIMOTHY PAUL CASSIDY JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP-C

Contact information

Practice address
310 S MARION AVE, LAKE CITY, FL 32025-7064
(386) 438-5722
(386) 438-8631
Mailing address
310 S MARION AVE, LAKE CITY, FL 32025-7064
(386) 438-5722
(386) 438-8631

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN9227994
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
FL
Enumeration date
12/03/2018
Last updated
07/17/2023
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