Provider Demographics
NPI:1306731005
Name:CAMACHO NARDO, ROXANA (PA)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:CAMACHO NARDO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8647 FANCY FINCH DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2382
Mailing Address - Country:US
Mailing Address - Phone:432-257-5435
Mailing Address - Fax:
Practice Address - Street 1:8647 FANCY FINCH DR UNIT 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2382
Practice Address - Country:US
Practice Address - Phone:432-257-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002605-P.A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care