MEDICARE: MISS CAMILLE BOCKER PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11003531	FL

General Provider Information

NPI Number	:	1447806146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CAMILLE BOCKER PMHNP-BC

Provider Business Mailing Address
First Line	:	4776 NEW BROAD ST STE 201
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6423
Country	:	US
Telephone Number	:	407-871-9490
Fax Number	:

Provider Business Practice Location Address
First Line	:	4776 NEW BROAD ST STE 201
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6423
Country	:	US
Telephone Number	:	407-871-9490
Fax Number	:

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

Provider Enumeration Date	:	08/18/2019
Last Update Date	:	03/10/2021

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