Healthcare Provider Details

I. General information

NPI: 1477223139
Provider Name (Legal Business Name): FLAVIA MARQUES CAMPOY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PINNACLES DR STE 201
PALM COAST FL
32164-2597
US

IV. Provider business mailing address

180 PINNACLES DR STE 201
PALM COAST FL
32164-2597
US

V. Phone/Fax

Practice location:
  • Phone: 877-212-7796
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11015385
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: