Provider Demographics
NPI:1346940947
Name:CAMILLE, BRITTANY ARLENE (FNP-BC, RN)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:ARLENE
Last Name:CAMILLE
Suffix:
Gender:F
Credentials:FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11357 LAKEPORT DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3470
Mailing Address - Country:US
Mailing Address - Phone:310-344-1027
Mailing Address - Fax:
Practice Address - Street 1:11357 LAKEPORT DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3470
Practice Address - Country:US
Practice Address - Phone:310-344-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA803915163W00000X
CA95024692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95024692Medicaid