Provider Demographics
NPI:1164516696
Name:CAMPAIOLA, JEAN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARY
Last Name:CAMPAIOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14036 SHIMMERING LAKE COURT
Mailing Address - Street 2:
Mailing Address - City:FT. MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-415-4845
Mailing Address - Fax:
Practice Address - Street 1:939 PONDELLA ROAD
Practice Address - Street 2:FACT TEAM
Practice Address - City:FT. MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903
Practice Address - Country:US
Practice Address - Phone:239-656-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME841502084P0800X
NC96-004742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF29261Medicare UPIN
2238160Medicare ID - Type Unspecified