Healthcare Provider Details

I. General information

NPI: 1629471602
Provider Name (Legal Business Name): DELISA CAUDILL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CATTLEMEN RD STE 204
SARASOTA FL
34232-6058
US

IV. Provider business mailing address

943 S BENEVA RD STE 306
SARASOTA FL
34232-2499
US

V. Phone/Fax

Practice location:
  • Phone: 941-379-1800
  • Fax: 941-379-1818
Mailing address:
  • Phone: 941-955-1108
  • Fax: 941-954-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008916
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11033598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: