Provider Demographics
NPI:1184203721
Name:CASSIDY HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:CASSIDY HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:386-438-5722
Mailing Address - Street 1:263 SW PROFESSIONAL GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1105
Mailing Address - Country:US
Mailing Address - Phone:386-438-5722
Mailing Address - Fax:386-438-8631
Practice Address - Street 1:310 S MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-7064
Practice Address - Country:US
Practice Address - Phone:386-438-5722
Practice Address - Fax:386-438-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty