Provider Demographics
NPI:1528752615
Name:BROWN, CAITLIN ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ROSE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 SAN JOSE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4288
Mailing Address - Country:US
Mailing Address - Phone:904-404-7044
Mailing Address - Fax:
Practice Address - Street 1:8823 SAN JOSE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4288
Practice Address - Country:US
Practice Address - Phone:904-404-7044
Practice Address - Fax:904-329-2303
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117913363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty