Provider Demographics
NPI:1548375298
Name:CAULEY PETILLO, FLORA FELICIA (APRN)
Entity type:Individual
Prefix:
First Name:FLORA
Middle Name:FELICIA
Last Name:CAULEY PETILLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:FLORA
Other - Middle Name:FELICIA
Other - Last Name:CAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 BRIGGS RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4100
Mailing Address - Country:US
Mailing Address - Phone:856-231-4774
Mailing Address - Fax:856-231-9699
Practice Address - Street 1:15 E NEWCASTLE RD
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-4725
Practice Address - Country:US
Practice Address - Phone:609-602-2908
Practice Address - Fax:609-399-5301
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP003943H363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018016970001Medicaid
NJ7702302Medicaid
NJ014919Medicare ID - Type Unspecified
S46834Medicare UPIN
PA004327Medicare ID - Type Unspecified