Healthcare Provider Details

I. General information

NPI: 1104585769
Provider Name (Legal Business Name): CAITLIN CHRISTINE CHARETTE-ZALEWSKI MS, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 NW HIGHWAY 41 SUITE B
JASPER FL
32052
US

IV. Provider business mailing address

22 MANOLA ST
CHICOPEE MA
01020-4465
US

V. Phone/Fax

Practice location:
  • Phone: 386-792-3864
  • Fax:
Mailing address:
  • Phone: 413-244-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11014463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: