Provider Demographics
NPI:1588035133
Name:FITZMAURICE, KASSANDA MARIE
Entity type:Individual
Prefix:
First Name:KASSANDA
Middle Name:MARIE
Last Name:FITZMAURICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11343 W TOWNLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-3408
Mailing Address - Country:US
Mailing Address - Phone:865-403-9203
Mailing Address - Fax:
Practice Address - Street 1:11343 W TOWNLEY AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-3408
Practice Address - Country:US
Practice Address - Phone:865-403-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8199363L00000X
NC5009427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner