Provider Demographics
NPI:1447761309
Name:CAMPBELL, JOYCELYN AMANDA
Entity Type:Individual
Prefix:
First Name:JOYCELYN
Middle Name:AMANDA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 W ANDERSON LN
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-8484
Mailing Address - Country:US
Mailing Address - Phone:352-270-8805
Mailing Address - Fax:
Practice Address - Street 1:907 W ANDERSON LN
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34434-8484
Practice Address - Country:US
Practice Address - Phone:352-270-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233420374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide