Provider Demographics
NPI:1447378609
Name:MCCATHRAN, CASSANDRA JANE (ROBERTSON)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JANE (ROBERTSON)
Last Name:MCCATHRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:MCCATHRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:719 BEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1823
Mailing Address - Country:US
Mailing Address - Phone:386-304-3444
Mailing Address - Fax:386-304-3403
Practice Address - Street 1:719 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1823
Practice Address - Country:US
Practice Address - Phone:386-304-3444
Practice Address - Fax:386-304-3403
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2626392363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO2537Medicare UPIN
FLE3852YMedicare ID - Type Unspecified