Provider Demographics
NPI:1609621432
Name:CALDWELL, JAMIE NICOLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICOLE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:KNOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1186 VIA ALTA
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5642
Mailing Address - Country:US
Mailing Address - Phone:805-260-4361
Mailing Address - Fax:
Practice Address - Street 1:1186 VIA ALTA
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5642
Practice Address - Country:US
Practice Address - Phone:805-260-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily