Healthcare Provider Details

I. General information

NPI: 1336826866
Provider Name (Legal Business Name): CAITLYN ANN BRAGA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLYN ANN THIBEAULT

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 OLD RIVER RD. SUITE 108
LINCOLN RI
02865-1397
US

IV. Provider business mailing address

132 OLD RIVER RD. SUITE 108
LINCOLN RI
02865-1397
US

V. Phone/Fax

Practice location:
  • Phone: 401-723-9250
  • Fax: 814-339-6165
Mailing address:
  • Phone: 401-723-9250
  • Fax: 814-339-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN04485
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: