Provider Demographics
NPI:1093801755
Name:CAMPBELL, THELMA M (CNM)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 NW 4TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:954-522-2979
Mailing Address - Fax:954-903-0633
Practice Address - Street 1:4101 NW 4TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-522-2979
Practice Address - Fax:954-903-0633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAN1400462163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302476800Medicaid