Provider Demographics
NPI:1407632714
Name:CARCAMO CAMPOS, MERCEDES ANDINA (MA)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:ANDINA
Last Name:CARCAMO CAMPOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 N DAVIS HWY STE 8
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6968
Mailing Address - Country:US
Mailing Address - Phone:850-525-5334
Mailing Address - Fax:
Practice Address - Street 1:6400 N DAVIS HWY STE 8
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6968
Practice Address - Country:US
Practice Address - Phone:850-525-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100919225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist