Provider Demographics
NPI:1922414499
Name:LIST, CASSANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:LIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-345-7373
Mailing Address - Fax:904-345-7372
Practice Address - Street 1:3901 UNIVERSITY BLVD S STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4374
Practice Address - Country:US
Practice Address - Phone:904-345-7373
Practice Address - Fax:904-345-7372
Is Sole Proprietor?:No
Enumeration Date:2014-07-06
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65962208100000X
FLME140105208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation