Healthcare Provider Details

I. General information

NPI: 1871414250
Provider Name (Legal Business Name): CHARMAINE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9785 CROSSHILL BLVD STE 108
JACKSONVILLE FL
32222-5889
US

IV. Provider business mailing address

715 E KING AVE APT 319
KINGSLAND GA
31548-4485
US

V. Phone/Fax

Practice location:
  • Phone: 904-772-6522
  • Fax: 904-772-6553
Mailing address:
  • Phone: 907-350-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA109520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: