Healthcare Provider Details

I. General information

NPI: 1922876085
Provider Name (Legal Business Name): CAMILLA GOMES XAVIER HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMILLA GOMES XAVIER

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5507 S CONGRESS AVE STE 130
ATLANTIS FL
33462-1139
US

IV. Provider business mailing address

PO BOX 20800
BELFAST ME
04915-4105
US

V. Phone/Fax

Practice location:
  • Phone: 561-227-7660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118289
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: