Provider Demographics
NPI:1164483939
Name:CAMPO, THERESA MARIE (DNP)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIE
Last Name:CAMPO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6713
Mailing Address - Country:US
Mailing Address - Phone:609-602-3034
Mailing Address - Fax:609-390-2725
Practice Address - Street 1:1925 PACIFIC AVE
Practice Address - Street 2:ARMC - ATLANTIC EMERGENCY ASSOCIATES
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6713
Practice Address - Country:US
Practice Address - Phone:609-602-3034
Practice Address - Fax:609-390-2725
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00004000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8805105Medicaid
NJ8805105Medicaid
NJ051888Medicare ID - Type Unspecified