Cassandra Ann Wallace-Wical, ARNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

ARNP9204048 Issued in FL

Practice address

2350 Sunset Point Rd Ste C
Clearwater, FL 33765-1443

Phone

(727) 797-3155

Fax

(727) 797-4301

NPI assigned

Mar 14, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: cassandra.wallace-wickelaprn@direct.mybaycare.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Suncoast Medical Clinic LLC

  • Multi-Specialty Clinic/Center
  • St Petersburg, FL
  • NPI 1497866537
  NPD (past)

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

{
    "created_epoch": "1268524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1124342563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 SUNSET POINT RD STE C",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337651443",
            "telephone_number": "727-797-3155",
            "fax_number": "727-797-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 SUNSET POINT RD STE C",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337651443",
            "telephone_number": "727-797-3155",
            "fax_number": "727-797-4301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6918 Gunn Hwy",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336253853",
            "country_code": "US",
            "telephone_number": "813-891-6310",
            "fax_number": "813-749-7938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE-WICAL",
        "first_name": "CASSANDRA",
        "middle_name": "ANN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-14",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "ARNP9204048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evelyn Walker
• James D Walker, PTA
• Joyce Lynn Walker, LMHC
• Stacy E Walker, D.C.
• David Michael Wall, MD
• Laura Wallace, ARNP
• Matthew A Wallace
• Paul R. Wallace, M.D.
• Richard Peterkin Wallace, M.D.
• Walmart Pharmacy

• Primary Care Nurse Practitioner in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Primary Care Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.