Provider Demographics
NPI:1902244429
Name:WESNOFSKE, CASSANDRA (APRN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:WESNOFSKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 CHIPARA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128
Mailing Address - Country:US
Mailing Address - Phone:615-394-9267
Mailing Address - Fax:
Practice Address - Street 1:12170 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2833
Practice Address - Country:US
Practice Address - Phone:727-586-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20576363LP0200X
FLARNP9361865363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008837000Medicaid