Provider Demographics
NPI:1407933542
Name:CALDWELL, JENNIFER A (RN, ANP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:FLOOD-CALDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, ANP
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-610-0488
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-610-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716176363LA2200X
NY304177363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176129801Medicaid
TX176129801Medicaid
TX176129801Medicaid