Healthcare Provider Details

I. General information

NPI: 1235485772
Provider Name (Legal Business Name): JAMILLA A. CAMPO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 03/16/2023
Certification Date: 10/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WEBSTER PL FL 2
EAST ORANGE NJ
07018-1706
US

IV. Provider business mailing address

20 WEBSTER PL FL 2
EAST ORANGE NJ
07018-1706
US

V. Phone/Fax

Practice location:
  • Phone: 718-679-2661
  • Fax: 862-933-9134
Mailing address:
  • Phone: 718-679-2661
  • Fax: 862-933-9134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number555492-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN762451
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number26NR20502500
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP027335
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: