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General NPI Number Information
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NPI Number | 1982103396
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Entity Type | Individual
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Provider Name | DUSTIN CAUDILL PA
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Gender | Male
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 1708 BLANDING BLVD
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City | MIDDLEBURG
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State | FL
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Zip | 32068-3836
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Country | US
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Telephone | 574-551-5160
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Fax |
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Provider Business Mailing Address
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Address Line | 705 CYPRESS CROSSING TRL
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32095-6808
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Country | US
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Telephone | 574-551-5160
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 55108
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9113302
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License Number State | FL
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