Provider Demographics
NPI:1083955074
Name:CAMPUZANO, CLAUDIA FERNANDA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:FERNANDA
Last Name:CAMPUZANO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LIELMANIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32566
Mailing Address - Country:US
Mailing Address - Phone:850-855-6626
Mailing Address - Fax:
Practice Address - Street 1:113 LIELMANIS AVENUE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32566
Practice Address - Country:US
Practice Address - Phone:850-855-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA910677363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical