Provider Demographics
NPI:1699194829
Name:CALDWELL, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10919 MISTLETOE DR
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-2801
Mailing Address - Country:US
Mailing Address - Phone:813-982-1050
Mailing Address - Fax:813-982-1070
Practice Address - Street 1:10919 MISTLETOE DR
Practice Address - Street 2:
Practice Address - City:THONOTOSASSA
Practice Address - State:FL
Practice Address - Zip Code:33592-2801
Practice Address - Country:US
Practice Address - Phone:813-982-1050
Practice Address - Fax:813-982-1070
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL110832310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility