Provider Demographics
NPI:1699931030
Name:CAMACHO, ARLYN LACUESTA (ARNP)
Entity type:Individual
Prefix:
First Name:ARLYN
Middle Name:LACUESTA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2580 METROCENTRE BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3100
Mailing Address - Country:US
Mailing Address - Phone:561-594-1840
Mailing Address - Fax:800-906-3055
Practice Address - Street 1:200 N LAKEMONT AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3273
Practice Address - Country:US
Practice Address - Phone:407-646-7812
Practice Address - Fax:407-303-0475
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9176221163WG0000X
FLAPRN9176221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBE804YMedicare PIN