Healthcare Provider Details

I. General information

NPI: 1376468272
Provider Name (Legal Business Name): JOANNE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 S FISKE BLVD STE 201
ROCKLEDGE FL
32955-3007
US

IV. Provider business mailing address

2944 LAWRENCE DR
MELBOURNE FL
32901-7254
US

V. Phone/Fax

Practice location:
  • Phone: 321-634-3688
  • Fax:
Mailing address:
  • Phone: 321-634-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: