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NPI Code Detail

MEDICARE: CAMILLA DAWN PACE FNP

MEDICARE: CAMILLA DAWN PACE FNP
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
1363LF0000XFamily Nurse PractitionerAPRN11001596FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740747047
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMILLA DAWN PACE FNP
Provider Business Mailing Address
First Line : PO BOX 1092
Second Line :
City : NEWBERRY
State : FL
Zip : 32669-1092
Country : US
Telephone Number : 352-354-5337
Fax Number :
Provider Business Practice Location Address
First Line : 4225 NW AMERICAN LN
Second Line :
City : LAKE CITY
State : FL
Zip : 32055-8841
Country : US
Telephone Number : 386-758-6141
Fax Number : 386-758-6140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2019
Last Update Date : 05/16/2022

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