Provider Demographics
NPI:1679056121
Name:GIBBS, CASSENDRE (CRNP)
Entity Type:Individual
Prefix:
First Name:CASSENDRE
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 MIDDLEFORD RD STE 501
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3664
Mailing Address - Country:US
Mailing Address - Phone:302-444-0190
Mailing Address - Fax:
Practice Address - Street 1:1350 MIDDLEFORD RD STE 501
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3664
Practice Address - Country:US
Practice Address - Phone:302-444-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9283365363L00000X
MDR235501363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner