Provider Demographics
NPI:1689610891
Name:CASSAGNOL, THERESA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:CASSAGNOL
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 1:4750 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2108
Mailing Address - Country:US
Mailing Address - Phone:561-422-6957
Mailing Address - Fax:561-422-7615
Practice Address - Street 1:VA MEDICAL CENTER (548/110)
Practice Address - Street 2:7305 NORTH MILITARY TRAIL
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-422-6957
Practice Address - Fax:561-422-7615
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2496992363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADOOMedicare UPIN