Provider Demographics
NPI:1962274688
Name:CAMPBELL, ANGELA TARA (MSN, CRNP, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:TARA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSN, CRNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W 8TH AVE STE I
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1349
Mailing Address - Country:US
Mailing Address - Phone:856-346-0005
Mailing Address - Fax:775-920-1548
Practice Address - Street 1:1010 W 8TH AVE STE I
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1349
Practice Address - Country:US
Practice Address - Phone:856-346-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO28411363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health