Provider Demographics
NPI:1518730142
Name:JENNINGS, CASSANDRA (LMT, LPN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LMT, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 GAZEBO PARK PL S STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1086
Mailing Address - Country:US
Mailing Address - Phone:904-260-3011
Mailing Address - Fax:904-260-4849
Practice Address - Street 1:6144 GAZEBO PARK PL S STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1086
Practice Address - Country:US
Practice Address - Phone:904-260-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1278991164W00000X
FLMA54006225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse