Provider Demographics
NPI:1285870337
Name:CASSIDY, AMY ELIZABETH (ACNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:ACNP-C
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:8328 E HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:480-214-9720
Mailing Address - Fax:480-214-9722
Practice Address - Street 1:8328 E HARTFORD DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:480-214-9720
Practice Address - Fax:480-214-9722
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13869363LA2100X
AZAP3853363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ581885Medicaid
AZZ142371Medicare PIN
Z142371Medicare PIN