Healthcare Provider Details

I. General information

NPI: 1720426364
Provider Name (Legal Business Name): CASSANDRA TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA PESNELL FNP

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALLE PORTAL STE 300
SIERRA VISTA AZ
85635-2900
US

IV. Provider business mailing address

1205 N F AVE
DOUGLAS AZ
85607-1920
US

V. Phone/Fax

Practice location:
  • Phone: 520-459-3011
  • Fax: 520-458-4467
Mailing address:
  • Phone: 520-364-1429
  • Fax: 520-515-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN128389
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5115
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN128389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: