MEDICARE: SABRINA NOELLE CASSIDY ARNP

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	363LF0000X	Family Nurse Practitioner	4704349572	MI
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0037985	OH
3	363LF0000X	Family Nurse Practitioner	29655	SC
4	363LF0000X	Family Nurse Practitioner	GAA-NP003004	GA
5	363LF0000X	Family Nurse Practitioner	3-001958	CO
6	363LF0000X	Family Nurse Practitioner	3-001958	AL
7	363LF0000X	Family Nurse Practitioner	1182776	TX
8	363LF0000X	Family Nurse Practitioner	4029892	KY
9	363LF0000X	Family Nurse Practitioner	0024195484	VA
10	363LF0000X	Family Nurse Practitioner	86583	NM
11	363LF0000X	Family Nurse Practitioner	APRN9269862	FL
12	363LF0000X	Family Nurse Practitioner	AP61627345	WA

General Provider Information

NPI Number	:	1366996076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA NOELLE CASSIDY ARNP

Provider Business Mailing Address
First Line	:	PO BOX 211699
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-3699
Country	:	US
Telephone Number	:	866-849-0692
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 HOWELL MILL RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-5557
Country	:	US
Telephone Number	:	866-849-0692
Fax Number	:

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

Provider Enumeration Date	:	08/10/2016
Last Update Date	:	12/01/2025

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