MEDICARE: JERALYNN ANN CAMPBELL-TRIPLETT

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	101YM0800X	Mental Health Counselor	251S00000X	FL

General Provider Information

NPI Number	:	1730622333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERALYNN ANN CAMPBELL-TRIPLETT

Provider Business Mailing Address
First Line	:	15501 BRUCE B DOWNS BLVD
Second Line	:	2208
City	:	TAMPA
State	:	FL
Zip	:	33647-1374
Country	:	US
Telephone Number	:	407-484-7897
Fax Number	:

Provider Business Practice Location Address
First Line	:	15501 BRUCE B DOWNS BLVD
Second Line	:	2208
City	:	TAMPA
State	:	FL
Zip	:	33647-1374
Country	:	US
Telephone Number	:	407-484-7897
Fax Number	:

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

Provider Enumeration Date	:	11/30/2016
Last Update Date	:	11/30/2016

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