Provider Demographics
NPI:1548904154
Name:MCCONATHA, CASSIE HUDSON (FNP-C, FNP-BC)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:HUDSON
Last Name:MCCONATHA
Suffix:
Gender:F
Credentials:FNP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4566 E HIGHWAY 20 STE 101
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-8839
Mailing Address - Country:US
Mailing Address - Phone:850-897-7546
Mailing Address - Fax:
Practice Address - Street 1:4566 E HIGHWAY 20 STE 101
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8839
Practice Address - Country:US
Practice Address - Phone:850-897-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily