MEDICARE: DR. CAROLINE M WOLVERTON DO

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	16583	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568957769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE M WOLVERTON DO

Provider Business Mailing Address
First Line	:	PO BOX 95590
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-0590
Country	:	US
Telephone Number	:	801-352-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 GULF BREEZE PKWY STE B
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4851
Country	:	US
Telephone Number	:	850-916-3680
Fax Number	:

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

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	01/21/2026

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