Provider Demographics
NPI:1508964040
Name:CAULFEILD-JAMES, SUSAN LYNN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNN
Last Name:CAULFEILD-JAMES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 DONEGAL DR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-6800
Mailing Address - Country:US
Mailing Address - Phone:850-937-8474
Mailing Address - Fax:
Practice Address - Street 1:5565 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8768
Practice Address - Country:US
Practice Address - Phone:850-994-5010
Practice Address - Fax:850-994-0272
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3180942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306625800Medicaid