MEDICARE: MRS. CAMMY D CAMPBELL ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APRN9296699	FL
2	363LF0000X	Family Nurse Practitioner	ARNP9296699	FL
3	363LF0000X	Family Nurse Practitioner	AP135096	TX
4	363LP2300X	Primary Care Nurse Practitioner	APRN9296699	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093254252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAMMY D CAMPBELL ARNP

Provider Business Mailing Address
First Line	:	1111 W FAIRBANKS AVE STE 200
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4777
Country	:	US
Telephone Number	:	407-635-5543
Fax Number	:	321-842-4002

Provider Business Practice Location Address
First Line	:	1111 W FAIRBANKS AVE STE 200
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4777
Country	:	US
Telephone Number	:	407-635-5543
Fax Number	:	321-842-4002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	12/04/2023

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