Provider Demographics
NPI:1053481242
Name:CAMPBELL, JENIEF A (RNP)
Entity Type:Individual
Prefix:MRS
First Name:JENIEF
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2306
Mailing Address - Country:US
Mailing Address - Phone:718-842-8040
Mailing Address - Fax:718-842-8394
Practice Address - Street 1:1055 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2306
Practice Address - Country:US
Practice Address - Phone:718-842-8040
Practice Address - Fax:718-842-8394
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner