Healthcare Provider Details

I. General information

NPI: 1265921464
Provider Name (Legal Business Name): KALYN V CAMERON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26606 MAGNOLIA BLVD
LUTZ FL
33559-8545
US

IV. Provider business mailing address

PO BOX 4706
TAMPA FL
33677-4706
US

V. Phone/Fax

Practice location:
  • Phone: 813-907-0123
  • Fax: 813-907-5559
Mailing address:
  • Phone: 813-280-0202
  • Fax: 813-280-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN9309406
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9309406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: