Provider Demographics
NPI:1033420815
Name:GREER, CASSIE STAR (ARNP)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:STAR
Last Name:GREER
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 1:1909 BEACH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2643
Mailing Address - Country:US
Mailing Address - Phone:904-246-2752
Mailing Address - Fax:904-246-2758
Practice Address - Street 1:12525 PHILIPS HWY STE 205&206
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3739
Practice Address - Country:US
Practice Address - Phone:904-880-1399
Practice Address - Fax:904-880-2946
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9217073363L00000X
FLAPRN9217073363LW0102X
FLELIGIBLE363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003466100Medicaid
FL47932OtherUNIVERSAL HEALTHCARE
FLP00929821OtherRAILROAD MCR
FL710410OtherWELLCARE
FLP934710OtherOPTIMUM
FLY06YROtherBCBS FL
FLP990169OtherFREEDOM HEALTH
FL003466100Medicaid