Provider Demographics
NPI:1053706895
Name:PRICKETT, CAITLIN DIANA (DO)
Entity type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:DIANA
Last Name:PRICKETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MEADOWS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2347
Mailing Address - Country:US
Mailing Address - Phone:561-961-3005
Mailing Address - Fax:561-516-8318
Practice Address - Street 1:825 MEADOWS RD STE 111
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2347
Practice Address - Country:US
Practice Address - Phone:561-961-3005
Practice Address - Fax:561-516-8318
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081209207R00000X
390200000X
FLOS18156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program