Provider Demographics
NPI:1558961250
Name:HOLMES, CASSANDRA JORDAN (CRNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JORDAN
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10467 WHITE GRANITE CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2718
Mailing Address - Country:US
Mailing Address - Phone:571-363-1163
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DRIVE LCIM NIAID NIH
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:240-506-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003287363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner