Healthcare Provider Details

I. General information

NPI: 1477195790
Provider Name (Legal Business Name): CAITLYN DIANE ANDERSEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLYN DIANE HELM PA

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE
STUART FL
34994-2346
US

IV. Provider business mailing address

PO BOX 9010
STUART FL
34995-9010
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-5200
  • Fax:
Mailing address:
  • Phone: 772-223-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9112642
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9112642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: