Provider Demographics
NPI:1780055152
Name:GNANN, KASSANDRA LEANN (ARNP)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:LEANN
Last Name:GNANN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 700 DEPAUL BLDG
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204
Mailing Address - Country:US
Mailing Address - Phone:904-389-5333
Mailing Address - Fax:904-389-5332
Practice Address - Street 1:1563 KINGSLEY AVENUE
Practice Address - Street 2:SUITE 106
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-389-5333
Practice Address - Fax:904-389-5332
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9337434363LF0000X
FLAPRN9337434363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015924400Medicaid