Provider Demographics
NPI:1588417737
Name:CAMINO, JENELLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:CAMINO
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15501 NE 15TH PL
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5645
Mailing Address - Country:US
Mailing Address - Phone:914-843-3757
Mailing Address - Fax:
Practice Address - Street 1:1837 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5207
Practice Address - Country:US
Practice Address - Phone:954-350-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9536383163WS0121X
FLAPRN11026524363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery