Provider Demographics
NPI:1508453549
Name:CAMPBELL, JONATHAN WESLEY (NP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WESLEY
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8114 RED JASPER LN APT 1208
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3572
Mailing Address - Country:US
Mailing Address - Phone:561-445-8592
Mailing Address - Fax:
Practice Address - Street 1:8114 RED JASPER LN APT 1208
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3572
Practice Address - Country:US
Practice Address - Phone:561-445-8592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily