Provider Demographics
NPI:1144861840
Name:CASSIDY, SHANTINA JENAE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SHANTINA
Middle Name:JENAE
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:SHANTINA
Other - Middle Name:JENAE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1101 CAROLINA STREET
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401
Mailing Address - Country:US
Mailing Address - Phone:336-333-6860
Mailing Address - Fax:
Practice Address - Street 1:1101 CAROLINA STREET
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1318
Practice Address - Country:US
Practice Address - Phone:336-333-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF08190124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily