Provider Demographics
NPI:1679991129
Name:CALDWELL, ANNETTE JENNINGS (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:JENNINGS
Last Name:CALDWELL
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:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32443-0017
Mailing Address - Country:US
Mailing Address - Phone:850-594-5503
Mailing Address - Fax:
Practice Address - Street 1:3971 SYLVANIA PLANTATION ROAD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:FL
Practice Address - Zip Code:32443-0017
Practice Address - Country:US
Practice Address - Phone:850-594-5503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3177572363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care