Healthcare Provider Details

I. General information

NPI: 1255653812
Provider Name (Legal Business Name): JESSICA L CAMP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE SOUTH
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

345 NORTH SMITH AVENUE
MINNEAPOLIS MN
55102
US

V. Phone/Fax

Practice location:
  • Phone: 352-871-8352
  • Fax:
Mailing address:
  • Phone: 352-871-8352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9232281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: