Provider Demographics
NPI:1891162384
Name:MOYER, CASANDRA (APRN)
Entity Type:Individual
Prefix:DR
First Name:CASANDRA
Middle Name:
Last Name:MOYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:DR
Other - First Name:CASANDRA
Other - Middle Name:
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, FNP-BC, PNP
Mailing Address - Street 1:7901 4TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4399
Mailing Address - Country:US
Mailing Address - Phone:843-474-5578
Mailing Address - Fax:843-790-1871
Practice Address - Street 1:2309 NORIEGA ST STE 888
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4239
Practice Address - Country:US
Practice Address - Phone:843-474-5578
Practice Address - Fax:843-790-1871
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002698363LF0000X, 363LP0200X, 363LP0808X
OR202109748363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics