Healthcare Provider Details

I. General information

NPI: 1851104574
Provider Name (Legal Business Name): CAITLIN RAE BOERSMA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 WINTER GARDEN VINELAND RD STE 206
WINDERMERE FL
34786-6098
US

IV. Provider business mailing address

5151 WINTER GARDEN VINELAND RD STE 206
WINDERMERE FL
34786-6098
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-4444
  • Fax: 407-643-2811
Mailing address:
  • Phone: 407-629-4444
  • Fax: 407-643-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA91120087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: