Provider Demographics
NPI:1922816065
Name:KROUS, CASSIE LYNAE (FNP-C)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:LYNAE
Last Name:KROUS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 BROOKHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4045
Mailing Address - Country:US
Mailing Address - Phone:509-688-4011
Mailing Address - Fax:
Practice Address - Street 1:616 BROOKHAVEN WAY
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-4045
Practice Address - Country:US
Practice Address - Phone:509-688-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily