Provider Demographics
NPI:1851732259
Name:CAICEDO, WILLIAM VIDAL (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:VIDAL
Last Name:CAICEDO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:TN
Mailing Address - Zip Code:38052-3433
Mailing Address - Country:US
Mailing Address - Phone:731-472-2147
Mailing Address - Fax:731-472-2148
Practice Address - Street 1:101 MAIN ST N
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:TN
Practice Address - Zip Code:38052-3433
Practice Address - Country:US
Practice Address - Phone:731-472-2147
Practice Address - Fax:731-472-2148
Is Sole Proprietor?:No
Enumeration Date:2013-07-13
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily