Provider Demographics
NPI:1699871053
Name:CAMPBELL, LATISHA ROCHELLE (CNM ARNP)
Entity type:Individual
Prefix:MS
First Name:LATISHA
Middle Name:ROCHELLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CNM ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-776-1500
Mailing Address - Fax:954-776-1501
Practice Address - Street 1:801 MEADOWS ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-391-0600
Practice Address - Fax:561-391-6001
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001087207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology