Healthcare Provider Details

I. General information

NPI: 1881219277
Provider Name (Legal Business Name): CAMDEN ELITE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10257 MAGNOLIA RIDGE DR
JACKSONVILLE FL
32210-4991
US

IV. Provider business mailing address

10257 MAGNOLIA RIDGE DR
JACKSONVILLE FL
32210-4991
US

V. Phone/Fax

Practice location:
  • Phone: 904-528-6357
  • Fax:
Mailing address:
  • Phone: 904-528-6357
  • Fax: 646-337-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LA TOYA DAWSON
Title or Position: BILLING DIRECTOR
Credential:
Phone: 352-231-7551