MEDICARE: DR. COLLEEN C CAMPBELL M.D.

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	207R00000X	Internal Medicine Physician	ME88894	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	:	1558384917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN C CAMPBELL M.D.

Provider Business Mailing Address
First Line	:	4221 N FLORIDA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-3819
Country	:	US
Telephone Number	:	813-539-6848
Fax Number	:	813-776-1613

Provider Business Practice Location Address
First Line	:	4221 N FLORIDA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-3819
Country	:	US
Telephone Number	:	813-539-6848
Fax Number	:	813-776-1613

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	11/18/2024

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