MEDICARE: ANGELA CABASSA CRNP

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	SP015791	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP015791	OTHER	PA	PA STATE NP LICENSE

General Provider Information

NPI Number	:	1417314634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA CABASSA CRNP

Provider Business Mailing Address
First Line	:	1600 E HIGH ST
Second Line	:
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-5093
Country	:	US
Telephone Number	:	610-327-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3309
Country	:	US
Telephone Number	:	215-746-7186
Fax Number	:

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

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	12/12/2019

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