MEDICARE: JENELLE CAMINO NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0121X	Plastic Surgery Registered Nurse	RN9536383	FL
2	363L00000X	Nurse Practitioner	APRN11026524	FL

General Provider Information

NPI Number	:	1588417737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENELLE CAMINO NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	15501 NE 15TH PL
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5645
Country	:	US
Telephone Number	:	914-843-3757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1837 N PINE ISLAND RD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-5207
Country	:	US
Telephone Number	:	954-350-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	05/16/2025

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