Healthcare Provider Details

I. General information

NPI: 1720297260
Provider Name (Legal Business Name): SU HO CAMPO A.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S EDISON AVE STE B
TAMPA FL
33606-1952
US

IV. Provider business mailing address

100 S EDISON AVE STE B
TAMPA FL
33606-1952
US

V. Phone/Fax

Practice location:
  • Phone: 138-217-5536
  • Fax: 813-200-1245
Mailing address:
  • Phone: 138-217-5536
  • Fax: 813-200-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberAP2153
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberAP2153
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2153
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: