Healthcare Provider Details

I. General information

NPI: 1477408755
Provider Name (Legal Business Name): CAITLIN NELLIGAN AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

851 TRAFALGAR CT STE 200E
MAITLAND FL
32751-7420
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2000
  • Fax:
Mailing address:
  • Phone: 407-667-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA1221
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: