MEDICARE: MS. REBECCA DIANE GASSETT RN, MS, CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95010004	CA
2	363LP0200X	Pediatric Nurse Practitioner	AP8597	AZ
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP8597	AZ

General Provider Information

NPI Number	:	1164504668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA DIANE GASSETT RN, MS, CPNP

Provider Business Mailing Address
First Line	:	550 W BASELINE RD STE 102183
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6031
Country	:	US
Telephone Number	:	602-688-4191
Fax Number	:	480-780-0665

Provider Business Practice Location Address
First Line	:	1250 E BASELINE RD STE 103
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1439
Country	:	US
Telephone Number	:	602-688-4191
Fax Number	:	480-780-0665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	01/19/2026

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