Healthcare Provider Details

I. General information

NPI: 1093254252
Provider Name (Legal Business Name): CAMMY D CAMPBELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W FAIRBANKS AVE STE 200
WINTER PARK FL
32789-4777
US

IV. Provider business mailing address

1111 W FAIRBANKS AVE STE 200
WINTER PARK FL
32789-4777
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-5543
  • Fax: 321-842-4002
Mailing address:
  • Phone: 407-635-5543
  • Fax: 321-842-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9296699
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9296699
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135096
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN9296699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: