Provider Demographics
NPI:1235384157
Name:CAMPBELL, CHRISTINE (MVP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MVP
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:15685 SCOTTY LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32466-1702
Mailing Address - Country:US
Mailing Address - Phone:850-722-9047
Mailing Address - Fax:850-722-9047
Practice Address - Street 1:15685 SCOTTY LANE
Practice Address - Street 2:
Practice Address - City:YOUGSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32466
Practice Address - Country:US
Practice Address - Phone:850-722-9047
Practice Address - Fax:850-722-9047
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA29590372500000X, 376K00000X
FLCNA29503747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688034796OtherMEDWAVER PROVDER NUMBER