Healthcare Provider Details

I. General information

NPI: 1114681970
Provider Name (Legal Business Name): RICHARD CAMPBELL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DON WICKHAM DR
CLERMONT FL
34711-1979
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 352-536-8840
  • Fax: 352-536-8841
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01215200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11038994
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: