Healthcare Provider Details

I. General information

NPI: 1235956517
Provider Name (Legal Business Name): ANTHONIEL CAMACHO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13275 W COLONIAL DR
WINTER GARDEN FL
34787-3984
US

IV. Provider business mailing address

110 S WOODLAND ST
WINTER GARDEN FL
34787-3546
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8827
  • Fax: 407-660-1667
Mailing address:
  • Phone: 407-905-8827
  • Fax: 407-660-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11043421
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: