Provider Demographics
NPI:1316528003
Name:CAMPBELL, LAJUANA D (APRN)
Entity type:Individual
Prefix:
First Name:LAJUANA
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33049 PROFESSIONAL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3705
Mailing Address - Country:US
Mailing Address - Phone:352-353-6967
Mailing Address - Fax:
Practice Address - Street 1:33049 PROFESSIONAL DR STE 103
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3705
Practice Address - Country:US
Practice Address - Phone:352-353-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010016363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner