MEDICARE: MRS. TASIA TRICIA CAMPBELL-ELLIS FNP

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	363LF0000X	Family Nurse Practitioner	11047097	FL

General Provider Information

NPI Number	:	1710814207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TASIA TRICIA CAMPBELL-ELLIS FNP

Provider Business Mailing Address
First Line	:	8281 BERMUDA SOUND WAY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-1727
Country	:	US
Telephone Number	:	863-877-9913
Fax Number	:

Provider Business Practice Location Address
First Line	:	8281 BERMUDA SOUND WAY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-1727
Country	:	US
Telephone Number	:	863-877-9913
Fax Number	:

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

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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