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NPI Code Detail

MEDICARE: MR. ANTONIO L CAMPBELL LPN

MEDICARE: MR. ANTONIO L CAMPBELL LPN
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
1164W00000XLicensed Practical NursePN5179511FL

General Provider Information

NPI Number : 1831750066
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANTONIO L CAMPBELL LPN
Provider Business Mailing Address
First Line : 525 E 15TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-5400
Country : US
Telephone Number : 850-522-4485
Fax Number :
Provider Business Practice Location Address
First Line : 525 E 15TH ST
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-5400
Country : US
Telephone Number : 850-522-4485
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2019
Last Update Date : 06/27/2019

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