Healthcare Provider Details

I. General information

NPI: 1598143810
Provider Name (Legal Business Name): CAITLIN CLELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 HOPE POND WAY UNIT 104
BLUFFTON SC
29910-3439
US

IV. Provider business mailing address

PO BOX 2330
BLUFFTON SC
29910-2330
US

V. Phone/Fax

Practice location:
  • Phone: 843-707-0006
  • Fax: 843-484-5359
Mailing address:
  • Phone: 843-837-4400
  • Fax: 843-837-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMPA 2332 TL
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: