Provider Demographics
NPI:1851104574
Name:BOERSMA, CAITLIN RAE (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:RAE
Last Name:BOERSMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6098
Mailing Address - Country:US
Mailing Address - Phone:407-629-4444
Mailing Address - Fax:407-643-2811
Practice Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 206
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6098
Practice Address - Country:US
Practice Address - Phone:407-629-4444
Practice Address - Fax:407-643-2811
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
FLPA91120087363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant