Provider Demographics
NPI:1639505258
Name:CASSEDAY, NICOLE (PAAA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CASSEDAY
Suffix:
Gender:F
Credentials:PAAA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:WIRBIEZCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAAA
Mailing Address - Street 1:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:866-507-5244
Mailing Address - Fax:954-858-1815
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:770-963-9905
Practice Address - Fax:770-962-9814
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006967367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant