Provider Demographics
NPI:1407487481
Name:CAMPUZANO, ALLYSON MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MARIE
Last Name:CAMPUZANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100905
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1273
Mailing Address - Country:US
Mailing Address - Phone:786-594-6880
Mailing Address - Fax:786-533-9261
Practice Address - Street 1:15955 SW 96TH ST STE 401
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1273
Practice Address - Country:US
Practice Address - Phone:786-467-3430
Practice Address - Fax:786-533-9695
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9112923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant