Healthcare Provider Details

I. General information

NPI: 1194283184
Provider Name (Legal Business Name): SANDRA CETOUTE GASSANT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N GLEBE RD STE 104
ARLINGTON VA
22203-3755
US

IV. Provider business mailing address

14905 MCKISSON CT APT A
SILVER SPRING MD
20906-6159
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-0703
  • Fax:
Mailing address:
  • Phone: 786-348-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024186140
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number637148
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC002865
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: