Provider Demographics
NPI:1861985095
Name:NOAH, CAITLIN ELIZABETH (IDMT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ELIZABETH
Last Name:NOAH
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-2730
Mailing Address - Country:US
Mailing Address - Phone:678-350-3221
Mailing Address - Fax:
Practice Address - Street 1:106 SUNSET DR
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2730
Practice Address - Country:US
Practice Address - Phone:678-350-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians