Provider Demographics
NPI:1356784136
Name:CAUDELL, JENNIFER CAROL (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAROL
Last Name:CAUDELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 PRICE RD
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6332
Mailing Address - Country:US
Mailing Address - Phone:706-344-9820
Mailing Address - Fax:
Practice Address - Street 1:6675 BUSINESS PKWY STE F
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6349
Practice Address - Country:US
Practice Address - Phone:866-799-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPRN159917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily