Provider Demographics
NPI:1194283184
Name:GASSANT, SANDRA CETOUTE (ARNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:CETOUTE
Last Name:GASSANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14905 MCKISSON CT APT A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6159
Mailing Address - Country:US
Mailing Address - Phone:786-348-5049
Mailing Address - Fax:
Practice Address - Street 1:200 N GLEBE RD STE 104
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-3755
Practice Address - Country:US
Practice Address - Phone:703-841-0703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186140363LF0000X
FL637148363LF0000X
MDAC002865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily