Provider Demographics
NPI:1265244115
Name:CAUDILL, EDWARD (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CAUDILL
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 N 28TH DR STE 270
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5639
Mailing Address - Country:US
Mailing Address - Phone:623-404-8505
Mailing Address - Fax:602-429-8475
Practice Address - Street 1:11022 N 28TH DR STE 270
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5639
Practice Address - Country:US
Practice Address - Phone:623-404-8505
Practice Address - Fax:602-429-8475
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ253121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily