Healthcare Provider Details

I. General information

NPI: 1033048467
Provider Name (Legal Business Name): CAMDEN JEFFREY COLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MARINER BLVD
SPRING HILL FL
34609-5691
US

IV. Provider business mailing address

260 MARINER BLVD
SPRING HILL FL
34609-5691
US

V. Phone/Fax

Practice location:
  • Phone: 352-810-0395
  • Fax:
Mailing address:
  • Phone: 352-810-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRBT-26-528266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: