Provider Demographics
NPI:1851072755
Name:ANDELLA, CASSANDRA ANN
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANN
Last Name:ANDELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13057 VIBURNUM DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1145
Mailing Address - Country:US
Mailing Address - Phone:978-502-3786
Mailing Address - Fax:
Practice Address - Street 1:13057 VIBURNUM DR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-1145
Practice Address - Country:US
Practice Address - Phone:978-502-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9416192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner