Provider Demographics
NPI:1497181986
Name:CAUDILL, JESSIE M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:M
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0900
Mailing Address - Country:US
Mailing Address - Phone:352-732-6599
Mailing Address - Fax:352-732-4816
Practice Address - Street 1:1025 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0900
Practice Address - Country:US
Practice Address - Phone:352-732-6599
Practice Address - Fax:352-732-4816
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28168439A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily