Provider Demographics
NPI:1376009464
Name:CASSIS, CHRISTOPHER MOURRA (APRN)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MOURRA
Last Name:CASSIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:MOURRA
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7917 NW 82ND CT
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1501
Mailing Address - Country:US
Mailing Address - Phone:305-778-3861
Mailing Address - Fax:
Practice Address - Street 1:21200 SAINT ANDREWS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2403
Practice Address - Country:US
Practice Address - Phone:561-409-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily