Provider Demographics
NPI:1730548272
Name:MORALES, CASSIDY JEAN (AG-ACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:JEAN
Last Name:MORALES
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:JEAN
Other - Last Name:BENAVIDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25500 N NORTERRA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:623-277-2370
Mailing Address - Fax:
Practice Address - Street 1:9069 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4412
Practice Address - Country:US
Practice Address - Phone:800-233-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8502363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care