Healthcare Provider Details

I. General information

NPI: 1700100310
Provider Name (Legal Business Name): WILLIAM MARTIN CAMPBELL SR. RN, CNOR, CRNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12880 COMMODITY PL
TAMPA FL
33626-3101
US

IV. Provider business mailing address

PO BOX 21686
TAMPA FL
33622-1686
US

V. Phone/Fax

Practice location:
  • Phone: 877-872-5788
  • Fax:
Mailing address:
  • Phone: 813-343-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN2148562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: