Provider Demographics
NPI:1235783218
Name:CHACON, CAMILLA RUTH (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:CAMILLA
Middle Name:RUTH
Last Name:CHACON
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9365 US HIGHWAY 19 N STE E
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-5400
Mailing Address - Country:US
Mailing Address - Phone:727-577-0285
Mailing Address - Fax:
Practice Address - Street 1:9365 US HIGHWAY 19 N STE E
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-5400
Practice Address - Country:US
Practice Address - Phone:727-577-0285
Practice Address - Fax:850-622-2053
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily