Provider Demographics
NPI:1235485772
Name:CAMPO, JAMILLA A (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMILLA
Middle Name:A
Last Name:CAMPO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WEBSTER PL FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1706
Mailing Address - Country:US
Mailing Address - Phone:718-679-2661
Mailing Address - Fax:862-933-9134
Practice Address - Street 1:20 WEBSTER PL FL 2
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1706
Practice Address - Country:US
Practice Address - Phone:718-679-2661
Practice Address - Fax:862-933-9134
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY555492-1163W00000X
PARN762451163W00000X
NJ26NR20502500163WG0000X
PASP027335363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice