Provider Demographics
NPI:1275393639
Name:CAMPA, JOAQUIN III (MPO)
Entity Type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:
Last Name:CAMPA
Suffix:III
Gender:M
Credentials:MPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 BRUCE B DOWNS BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3906
Mailing Address - Country:US
Mailing Address - Phone:813-683-5972
Mailing Address - Fax:
Practice Address - Street 1:14201 BRUCE B DOWNS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3906
Practice Address - Country:US
Practice Address - Phone:813-683-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL216224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist