Provider Demographics
NPI:1407524275
Name:CROMWELL, CAMILLE (FNP)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 WALL ST UNIT 543
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-7023
Mailing Address - Country:US
Mailing Address - Phone:858-255-0416
Mailing Address - Fax:
Practice Address - Street 1:864 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4200
Practice Address - Country:US
Practice Address - Phone:775-722-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily