Provider Demographics
NPI:1427767599
Name:SMITH, CAITLIN JANE (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 S RIDGEWOOD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-5170
Mailing Address - Country:US
Mailing Address - Phone:386-304-7070
Mailing Address - Fax:386-304-7050
Practice Address - Street 1:5111 S RIDGEWOOD AVE STE 301
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-5170
Practice Address - Country:US
Practice Address - Phone:386-304-7070
Practice Address - Fax:386-304-7050
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022699363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner