MEDICARE: CAROLINE PRIDGEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9120415	FL

General Provider Information

NPI Number	:	1831085935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE PRIDGEN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-274-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEMORIAL MEDICAL PKWY STE 200
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5979
Country	:	US
Telephone Number	:	386-586-1860
Fax Number	:	386-586-1861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	03/09/2026

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Directions to “ CAROLINE PRIDGEN PA-C” Practice Location

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