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General NPI Number Information
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NPI Number | 1205226321
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Entity Type | Individual
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Provider Name | NICOLE A CAMPOS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 500 WINDERLEY PL SUITE 115
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City | MAITLAND
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State | FL
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Zip | 32751-7247
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Country | US
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Telephone | 407-875-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 5465 FACTORS WALK DR
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City | SANFORD
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State | FL
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Zip | 32771-8535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9108497
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License Number State | FL
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