Provider Demographics
NPI:1508156357
Name:CASSIS, JIMMY PETER (ARNP)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:PETER
Last Name:CASSIS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 NE 21ST WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2524
Mailing Address - Country:US
Mailing Address - Phone:954-530-8638
Mailing Address - Fax:
Practice Address - Street 1:404 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1942
Practice Address - Country:US
Practice Address - Phone:954-530-8638
Practice Address - Fax:954-530-8638
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2642392363LP0808X
FLARNP 2642392363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014428800Medicaid
FLID168ZOtherMEDICARE PTAN
FLID168ZOtherMEDICARE PTAN