Provider Demographics
NPI:1184659484
Name:CAMP, VICTORIA JEAN (DPM, PA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JEAN
Last Name:CAMP
Suffix:
Gender:F
Credentials:DPM, PA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:JEAN
Other - Last Name:CAMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM, PA
Mailing Address - Street 1:150 SOUTHPARK BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-810-0391
Mailing Address - Fax:904-810-0392
Practice Address - Street 1:1093 A1A BEACH BLVD
Practice Address - Street 2:PMB 235
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6733
Practice Address - Country:US
Practice Address - Phone:904-814-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3094213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3404633Medicaid
V00804Medicare UPIN
65844ZMedicare ID - Type Unspecified