Provider Demographics
NPI:1467718007
Name:MCCAULIE, JOAN HELEN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:HELEN
Last Name:MCCAULIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:11513 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4002
Practice Address - Country:US
Practice Address - Phone:904-751-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019652207R00000X
OH34.013565207R00000X
NC2018-02013207R00000X
CA20A13460207R00000X
TXS0941207R00000X
FLOS16429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL1128OtherMEDICARE
FL104925400Medicaid
FLZL9INOtherBCBS
030017500OtherDEPT OF LABOR
VA007610581Medicaid
WV00031718OtherMOUNTAIN STATE BLUE CROSS
WV0001209000Medicaid
VA009818707Medicaid
WV510071Medicare Oscar/Certification