Provider Demographics
NPI:1245266493
Name:CASSARINO, DOREEN W (ARNP)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:W
Last Name:CASSARINO
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:1495 PINE RIDGE RD STE 4
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2113
Practice Address - Country:US
Practice Address - Phone:239-594-5456
Practice Address - Fax:239-592-5456
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1363992363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306708400Medicaid
FLY066NOtherBLUE SHIELD
FL40916FOtherBLUE CROSS
FLP35314Medicare UPIN