Healthcare Provider Details

I. General information

NPI: 1245596550
Provider Name (Legal Business Name): MR. ROBERT COOPER CAMPBELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N ANDREWS AVE
WILTON MANORS FL
33311-2514
US

IV. Provider business mailing address

2800 N ANDREWS AVE
WILTON MANORS FL
33311-2514
US

V. Phone/Fax

Practice location:
  • Phone: 954-522-4749
  • Fax:
Mailing address:
  • Phone: 954-522-4749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: