Healthcare Provider Details

I. General information

NPI: 1790193746
Provider Name (Legal Business Name): LYNA CAMPO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNA CAMPO ELLIS MD

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SIMMONS LOOP
RIVERVIEW FL
33578-9498
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-302-8388
  • Fax:
Mailing address:
  • Phone: 727-532-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME140818
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: