Healthcare Provider Details

I. General information

NPI: 1972449320
Provider Name (Legal Business Name): CASSANDRA MAE CORSARO AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSIE CORSARO NP

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 JERRY AVE
ESCALON CA
95320-2141
US

IV. Provider business mailing address

1652 JERRY AVE
ESCALON CA
95320-2141
US

V. Phone/Fax

Practice location:
  • Phone: 904-412-6272
  • Fax:
Mailing address:
  • Phone: 904-412-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number827914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: