Healthcare Provider Details

I. General information

NPI: 1528728524
Provider Name (Legal Business Name): PAUL J CHAMPINO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E COUNTY ROAD 540A
LAKELAND FL
33813-3825
US

IV. Provider business mailing address

1337 STRATTON DR
LAKELAND FL
33813-2353
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7190
  • Fax: 866-264-8519
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11016653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: