Healthcare Provider Details

I. General information

NPI: 1487355822
Provider Name (Legal Business Name): ABIGAIL TIODIN VANCAMPENHOUT APNP, FNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 US HIGHWAY 1 S
ST AUGUSTINE FL
32086-6000
US

IV. Provider business mailing address

2095 US HIGHWAY 1 S
SAINT AUGUSTINE FL
32086-6000
US

V. Phone/Fax

Practice location:
  • Phone: 866-765-2684
  • Fax:
Mailing address:
  • Phone: 414-391-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13682-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11040590
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number170690-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: