Provider Demographics
NPI:1467937516
Name:GRUBER, CASSIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CASSIE
Middle Name:
Last Name:GRUBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 LOMA LINDA ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2206
Mailing Address - Country:US
Mailing Address - Phone:941-544-0964
Mailing Address - Fax:
Practice Address - Street 1:1630 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3108
Practice Address - Country:US
Practice Address - Phone:941-556-6900
Practice Address - Fax:941-556-6920
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111577363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty