Healthcare Provider Details

I. General information

NPI: 1316944911
Provider Name (Legal Business Name): CHERYL LYNN CAMPOLO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

17072 NW 15TH ST
PEMBROKE PINES FL
33028-1351
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-9438
  • Fax:
Mailing address:
  • Phone: 954-347-0922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP972412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: