Provider Demographics
NPI:1003326976
Name:SCASSA, ANTONIO (BSN RN MSN CNP)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:SCASSA
Suffix:
Gender:M
Credentials:BSN RN MSN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 MERCY DR NW STE 506
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2625
Mailing Address - Country:US
Mailing Address - Phone:330-588-4575
Mailing Address - Fax:
Practice Address - Street 1:125 CANTON RD NW STE A
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1009
Practice Address - Country:US
Practice Address - Phone:330-627-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH381666163W00000X
OHAPRN.CNP.021890363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0252161Medicaid