Provider Demographics
NPI:1104355908
Name:WESTBROOK, CASSANDRA A (FNP-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:A
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4088 BROOKSIDE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7800
Mailing Address - Country:US
Mailing Address - Phone:770-686-3428
Mailing Address - Fax:
Practice Address - Street 1:4088 BROOKSIDE MANOR DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7800
Practice Address - Country:US
Practice Address - Phone:770-686-3428
Practice Address - Fax:770-686-3428
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily