MEDICARE: MR. ERIC R CAMPILLO-JUIG APRN

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	363L00000X	Nurse Practitioner	ARNP 9292654	FL
2	363LF0000X	Family Nurse Practitioner	RN9292654	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP 9292654	FL
4	101YM0800X	Mental Health Counselor	LMHC9123	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205039005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC R CAMPILLO-JUIG APRN

Provider Business Mailing Address
First Line	:	6583 SW 39TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4821
Country	:	US
Telephone Number	:	786-615-3187
Fax Number	:	786-756-1010

Provider Business Practice Location Address
First Line	:	6583 SW 39TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4821
Country	:	US
Telephone Number	:	786-615-3187
Fax Number	:	786-756-1010

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	11/08/2023

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