Provider Demographics
NPI:1558384917
Name:CAMPBELL, COLLEEN C (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:C
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3819
Mailing Address - Country:US
Mailing Address - Phone:813-539-6848
Mailing Address - Fax:813-776-1613
Practice Address - Street 1:4221 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3819
Practice Address - Country:US
Practice Address - Phone:813-539-6848
Practice Address - Fax:813-776-1613
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281186300Medicaid
FL82103ZMedicare PIN
FL281186300Medicaid