Healthcare Provider Details

I. General information

NPI: 1609294354
Provider Name (Legal Business Name): LEONARDO CAMPERO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 CREEKSIDE BLVD
NAPLES FL
34108-1931
US

IV. Provider business mailing address

430 MEADOWLARK LN UNIT B
NAPLES FL
34105-2989
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-1158
  • Fax:
Mailing address:
  • Phone: 239-280-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9308904
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: