MEDICARE: DARLENE CAULDER APRN

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	249017	GA
2	363L00000X	Nurse Practitioner	APRN11023567	FL
3	363LF0000X	Family Nurse Practitioner	APRN11023567	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	249017	OTHER	GA	RN LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	F10221402	OTHER	GA	FNP-C
4	9615341	OTHER	FL	RN LICENSE
5	APRN11023567	OTHER	FL	ADVANCED PRACTICE REGISTERED NURSE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1427521756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE CAULDER APRN

Provider Business Mailing Address
First Line	:	4354 S LECANTO HWY
Second Line	:
City	:	LECANTO
State	:	FL
Zip	:	34461-9032
Country	:	US
Telephone Number	:	478-972-7021
Fax Number	:

Provider Business Practice Location Address
First Line	:	3925 N LECANTO HWY
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3507
Country	:	US
Telephone Number	:	844-797-8425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	10/16/2024

3923 N LECANTO HWY
BEVERLY HILLS, FL
34465-3507

Practice Phone: 352-637-4330
Practice Fax: 352-527-9766