Provider Demographics
NPI:1609769488
Name:STEPHENS, CASSANDRA DIONNE (APRN)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:DIONNE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:DIONNE
Other - Last Name:STEPHENS-JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:3140 NW 4TH PL
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33311-8422
Mailing Address - Country:US
Mailing Address - Phone:954-839-5625
Mailing Address - Fax:
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-839-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11039618363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily