Provider Demographics
NPI:1851104574
Name:BOERSMA, CAITLIN RAE (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:RAE
Last Name:BOERSMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 KAWILLA CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4811
Mailing Address - Country:US
Mailing Address - Phone:954-325-4512
Mailing Address - Fax:
Practice Address - Street 1:128 KAWILLA CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4811
Practice Address - Country:US
Practice Address - Phone:954-325-4512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant