Healthcare Provider Details

I. General information

NPI: 1255030367
Provider Name (Legal Business Name): CASSANDRA CERVANTES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 ALMAVILLE RD
SMYRNA TN
37167-5748
US

IV. Provider business mailing address

1923 ALMAVILLE RD
SMYRNA TN
37167-5748
US

V. Phone/Fax

Practice location:
  • Phone: 615-768-8021
  • Fax:
Mailing address:
  • Phone: 615-768-8024
  • Fax: 615-768-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5550
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5550
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: