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General NPI Number Information
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NPI Number | 1447022199
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Entity Type | Individual
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Provider Name | CAITLIN KERRI GAVITT PNP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 12105 ROCKAWAY BEACH BLVD
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-1821
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Country | US
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Telephone | 718-412-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 103 ABBEY CT
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City | BROOKLYN
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State | NY
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Zip | 11229-6065
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Country | US
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Telephone | 917-757-0406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 383646
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License Number State | NY
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