MEDICARE: MRS. STEPHANIE CAMPOS NURSE PRACTITIONER

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	11019903	FL

General Provider Information

NPI Number	:	1982343927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE CAMPOS NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	8898 SW 229TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33190-1962
Country	:	US
Telephone Number	:	786-557-5773
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 NW 12TH AVE # C4
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33128-2205
Country	:	US
Telephone Number	:	786-557-5773
Fax Number	:

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

Provider Enumeration Date	:	05/28/2022
Last Update Date	:	05/28/2022

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