Healthcare Provider Details

I. General information

NPI: 1982596847
Provider Name (Legal Business Name): MARIA RACHEL CAUDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 N US HIGHWAY 1
FORT PIERCE FL
34946-7331
US

IV. Provider business mailing address

5600 N US HIGHWAY 1
FORT PIERCE FL
34946-7331
US

V. Phone/Fax

Practice location:
  • Phone: 772-242-2400
  • Fax:
Mailing address:
  • Phone: 772-242-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11035331
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: