Provider Demographics
NPI:1053293639
Name:CAMPBELL, MEGAN MARIE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13990 BARTRAM PARK BLVD UNIT 2621
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5578
Mailing Address - Country:US
Mailing Address - Phone:904-318-9873
Mailing Address - Fax:904-318-9873
Practice Address - Street 1:3205 VARELLA AVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2096
Practice Address - Country:US
Practice Address - Phone:904-547-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer