Provider Demographics
NPI:1154002004
Name:CAMPBELL, LUKE A (CRNA)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 SW 8TH ST UNIT 2012
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3792
Mailing Address - Country:US
Mailing Address - Phone:903-721-2083
Mailing Address - Fax:
Practice Address - Street 1:9300 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3205
Practice Address - Country:US
Practice Address - Phone:903-721-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023335367500000X
FLAPRN11010732367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered