Healthcare Provider Details

I. General information

NPI: 1700331840
Provider Name (Legal Business Name): CAITLIN MCCAFFREY ROSENBLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SUMMIT BLVD STE 240
PENSACOLA FL
32503-3357
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-746-0600
  • Fax: 850-416-1912
Mailing address:
  • Phone: 904-450-6014
  • Fax: 904-450-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109895
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: