Provider Demographics
NPI:1093254252
Name:CAMPBELL, CAMMY D (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CAMMY
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W FAIRBANKS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4777
Mailing Address - Country:US
Mailing Address - Phone:407-635-5543
Mailing Address - Fax:321-842-4002
Practice Address - Street 1:1111 W FAIRBANKS AVE STE 200
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4777
Practice Address - Country:US
Practice Address - Phone:407-635-5543
Practice Address - Fax:321-842-4002
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9296699363LA2200X, 363LP2300X
FLARNP9296699363LF0000X
TXAP135096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily