Basic Information
| Provider Information | |||||||||
| NPI: | 1750671178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3090 CARUSO CT STE 50 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328068510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074817179 | ||||||||
| FaxNumber: | 4074817190 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 DON WICKHAM DR | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347111979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525368840 | ||||||||
| FaxNumber: | 3525368841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | LG0000555 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | ARNP9445797 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.