Provider Demographics
NPI:1306279807
Name:CACULITAN, MILCAH GRACE S (FNP)
Entity type:Individual
Prefix:
First Name:MILCAH GRACE
Middle Name:S
Last Name:CACULITAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 CARLTON AVE
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4348
Mailing Address - Country:US
Mailing Address - Phone:863-676-6386
Mailing Address - Fax:863-676-6452
Practice Address - Street 1:1120 CARLTON AVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4348
Practice Address - Country:US
Practice Address - Phone:863-676-6386
Practice Address - Fax:863-676-6452
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3193432363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner