Provider Demographics
NPI:1598929192
Name:GORDEN, CAMILLE CHRISTINE (ARNP)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:CHRISTINE
Last Name:GORDEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:CHRISTINE
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:13770 BEACH BLVD
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7205
Mailing Address - Country:US
Mailing Address - Phone:904-242-4220
Mailing Address - Fax:904-242-4221
Practice Address - Street 1:13770 BEACH BLVD
Practice Address - Street 2:SUITE # 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7205
Practice Address - Country:US
Practice Address - Phone:904-242-4220
Practice Address - Fax:904-242-4221
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-12
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9279833363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003867800Medicaid