Provider Demographics
NPI:1225051568
Name:NICDAO, CARMELITA OCAMPO (MD)
Entity Type:Individual
Prefix:
First Name:CARMELITA
Middle Name:OCAMPO
Last Name:NICDAO
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 1:928 SAN RAPHAEL ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3907
Mailing Address - Country:US
Mailing Address - Phone:863-496-1234
Mailing Address - Fax:863-496-2070
Practice Address - Street 1:1050 GRAPE AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-3965
Practice Address - Country:US
Practice Address - Phone:407-892-2973
Practice Address - Fax:407-943-6468
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20377207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052520100Medicaid
FL052520100Medicaid
D55552Medicare UPIN