Healthcare Provider Details

I. General information

NPI: 1356784136
Provider Name (Legal Business Name): JENNIFER CAROL CAUDELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 BUSINESS PKWY STE F
ELKRIDGE MD
21075-6349
US

IV. Provider business mailing address

919 PRICE RD
DAWSONVILLE GA
30534-6332
US

V. Phone/Fax

Practice location:
  • Phone: 866-799-5886
  • Fax:
Mailing address:
  • Phone: 706-344-9820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN159917
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: