Provider Demographics
NPI:1285961219
Name:CAMPBELL, ANDREA (ARNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
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 1:1879 NIGHTINGALE LN
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4363
Mailing Address - Country:US
Mailing Address - Phone:352-742-1171
Mailing Address - Fax:352-742-7241
Practice Address - Street 1:1879 NIGHTINGALE LN
Practice Address - Street 2:SUITE C-1
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4363
Practice Address - Country:US
Practice Address - Phone:352-742-1171
Practice Address - Fax:352-742-7241
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3394822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCU642ZMedicare PIN