Healthcare Provider Details

I. General information

NPI: 1508788852
Provider Name (Legal Business Name): ANJEANETTE CALDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FRANDORSON CIR STE 4234
APOLLO BEACH FL
33572-2648
US

IV. Provider business mailing address

7614 SUNSHINE BRIDGE AVE
GIBSONTON FL
33534-5695
US

V. Phone/Fax

Practice location:
  • Phone: 813-324-5523
  • Fax:
Mailing address:
  • Phone: 863-604-3265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT26-2833862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: