Provider Demographics
NPI:1366996076
Name:CASSIDY, SABRINA NOELLE (ARNP)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:NOELLE
Last Name:CASSIDY
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:NOELLE
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:
Practice Address - Street 1:880 SW 145TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-6166
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704349572363LF0000X
TX1182776363LF0000X
AL3-001958363LF0000X
CO3-001958363LF0000X
WAAP61627345363LF0000X
SC29655363LF0000X
KY4029892363LF0000X
OHAPRN.CNP.0037985363LF0000X
FLAPRN9269862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty