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General NPI Number Information
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NPI Number | 1609470897
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Entity Type | Individual
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Provider Name | CARRIE DENISE CAMPBELL
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Gender | Female
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Dates
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Enumeration Date | 11/28/2020
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Last Update Date | 11/28/2020
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Provider Practice Location Address
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Address Line | 1031 BLACKWOLF RUN RD
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City | DAVENPORT
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State | FL
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Zip | 33896-7951
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Country | US
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Telephone | 863-226-8553
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1752
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City | WINTER HAVEN
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State | FL
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Zip | 33882-1752
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Country | US
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Telephone | 863-226-8553
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | C514-104-76-582-0
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License Number State | FL
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