Provider Demographics
NPI:1659141372
Name:HARRELSON, CAITLYN MICHALSKI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:MICHALSKI
Last Name:HARRELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CAITLYN
Other - Middle Name:MAE
Other - Last Name:MICHALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13556 154TH PL N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-8509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1680 S CENTRAL BLVD STE 112
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7395
Practice Address - Country:US
Practice Address - Phone:772-276-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant