MEDICARE: MR. EDGAR CAMACHO JR. FNP-C

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	363L00000X	Nurse Practitioner	11026349	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1841981545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDGAR CAMACHO JR. FNP-C

Provider Business Mailing Address
First Line	:	14850 LAMOINE DR
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96003-7019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 SW 73RD AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2635
Country	:	US
Telephone Number	:	305-250-9998
Fax Number	:

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

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	05/15/2023

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