Provider Demographics
NPI:1205039005
Name:CAMPILLO-JUIG, ERIC R (APRN)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:CAMPILLO-JUIG
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6583 SW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4821
Mailing Address - Country:US
Mailing Address - Phone:786-615-3187
Mailing Address - Fax:786-756-1010
Practice Address - Street 1:6583 SW 39TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4821
Practice Address - Country:US
Practice Address - Phone:786-615-3187
Practice Address - Fax:786-756-1010
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9292654363L00000X, 363LP0808X
FLRN9292654363LF0000X
FLLMHC9123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022-677-800Medicaid
FL020-979-000Medicaid