Healthcare Provider Details

I. General information

NPI: 1164516696
Provider Name (Legal Business Name): JEAN MARY CAMPAIOLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 PONDELLA ROAD FACT TEAM
FT. MYERS FL
33903
US

IV. Provider business mailing address

14036 SHIMMERING LAKE COURT
FT. MYERS FL
33907
US

V. Phone/Fax

Practice location:
  • Phone: 239-656-3461
  • Fax:
Mailing address:
  • Phone: 239-415-4845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME84150
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number96-00474
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: