Healthcare Provider Details

I. General information

NPI: 1184659484
Provider Name (Legal Business Name): VICTORIA JEAN CAMP DPM, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA JEAN CAMP DPM, PA

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1093 A1A BEACH BLVD PMB 235
ST AUGUSTINE FL
32080-6733
US

IV. Provider business mailing address

150 SOUTHPARK BLVD STE 202
ST AUGUSTINE FL
32086
US

V. Phone/Fax

Practice location:
  • Phone: 904-814-4904
  • Fax:
Mailing address:
  • Phone: 904-810-0391
  • Fax: 904-810-0392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: