Provider Demographics
NPI:1326590159
Name:CAMPBELL, RICARDO (FNP)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 SW 64TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4400
Mailing Address - Country:US
Mailing Address - Phone:954-424-4321
Mailing Address - Fax:954-424-0765
Practice Address - Street 1:4780 DAVIE RD STE 101
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4400
Practice Address - Country:US
Practice Address - Phone:954-434-1705
Practice Address - Fax:954-434-1882
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9319931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily