Provider Demographics
NPI:1508381880
Name:CAMBLIN, MARCIE MARIE (MSN, ACNPC-AG, CCRN)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:MARIE
Last Name:CAMBLIN
Suffix:
Gender:F
Credentials:MSN, ACNPC-AG, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16551 N NAEGEL DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5411
Mailing Address - Country:US
Mailing Address - Phone:623-764-7402
Mailing Address - Fax:
Practice Address - Street 1:16551 N NAEGEL DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5411
Practice Address - Country:US
Practice Address - Phone:623-764-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10481363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP10481OtherARIZONA STATE BOARD
2000025194OtherAMERICAN ASSOCIATION OF CRITICAL CARE NURSING