Healthcare Provider Details

I. General information

NPI: 1053706895
Provider Name (Legal Business Name): CAITLIN DIANA PRICKETT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 MEADOWS RD STE 111
BOCA RATON FL
33486-2347
US

IV. Provider business mailing address

825 MEADOWS RD STE 111
BOCA RATON FL
33486-2347
US

V. Phone/Fax

Practice location:
  • Phone: 561-961-3005
  • Fax: 561-516-8318
Mailing address:
  • Phone: 561-961-3005
  • Fax: 561-516-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number081209
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS18156
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: