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General NPI Number Information
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NPI Number | 1972117026
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Entity Type | Individual
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Provider Name | CHARSETTA DENISE CAMPBELL APRN
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Gender | Female
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Dates
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Enumeration Date | 09/06/2020
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 5771 ROOSEVELT BLVD
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City | CLEARWATER
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State | FL
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Zip | 33760-3407
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Country | US
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Telephone | 727-523-2460
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Fax |
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Provider Business Mailing Address
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Address Line | 14406 EDINBURGH MOOR DR
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City | WIMAUMA
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State | FL
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Zip | 33598-6153
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Country | US
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Telephone | 813-508-0595
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 109574500
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11009006
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License Number State | FL
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