Healthcare Provider Details

I. General information

NPI: 1285870337
Provider Name (Legal Business Name): AMY ELIZABETH CASSIDY ACNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ELIZABETH WAGNER ACNP-BC

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8328 E HARTFORD DR
SCOTTSDALE AZ
85255
US

IV. Provider business mailing address

8328 E HARTFORD DR
SCOTTSDALE AZ
85255
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-9720
  • Fax: 480-214-9722
Mailing address:
  • Phone: 480-214-9720
  • Fax: 480-214-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP3853
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number13869
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: