Provider Demographics
NPI:1023543915
Name:LUGO, CASSIDI ANNE SORENSEN (APRN)
Entity Type:Individual
Prefix:
First Name:CASSIDI
Middle Name:ANNE SORENSEN
Last Name:LUGO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CASSIDI
Other - Middle Name:ANNE
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:2111 W SWANN AVE STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2478
Practice Address - Country:US
Practice Address - Phone:813-254-7227
Practice Address - Fax:813-253-0285
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9367261363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110658000Medicaid