Organization Active NPI

Sanara Clinical Services PLLC

  • Family Nurse Practitioner
  • Fruitland Park, FL
National Provider Identifier
1063205425
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
SANARA CLINICAL SERVICES PLLC
Practice address
1221 Atlantic Ave
Fruitland Park, FL 34731-3245
Phone
(352) 399-8124
NPI assigned
May 27, 2025
Last updated
Jun 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessica CassellaNPI 1548834450
Title
Practice Owner
Phone
(352) 399-8124

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

1221 Atlantic Ave
Fruitland Park, FL 34731-3245

Mailing address

1221 Atlantic Ave
Fruitland Park, FL 34731-3245

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250603002220 FL Part B Supplier - Clinic/Group Practice 0143739920 Receives reassigned benefits from 1 practitioner
Practice locations: Fruitland Park, FL

National Provider Directory

National Provider Directory

Locations

104 W Miller St
Unit 435
Fruitland Park, FL 34731
Phone (352) 399-8124

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782777600000",
    "number": "1063205425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 ATLANTIC AVE",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "347313245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 ATLANTIC AVE",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "347313245",
            "telephone_number": "352-399-8124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANARA CLINICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-27",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A",
        "authorized_official_last_name": "CASSELLA",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "352-399-8124"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fruitland Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.