Provider Demographics
NPI:1538296249
Name:CAMP, WENDY LINETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LINETTE
Last Name:CAMP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LINETTE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:800 PRUDENTIAL DR
Mailing Address - Street 2:TOWER B, 11TH FLOOR
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8202
Mailing Address - Country:US
Mailing Address - Phone:904-388-6518
Mailing Address - Fax:904-384-1005
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:TOWER B, 11TH FLOOR
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8202
Practice Address - Country:US
Practice Address - Phone:904-388-6518
Practice Address - Fax:904-384-1005
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9218994363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3081800-00Medicaid
GA191982741AMedicaid
GA191982741AMedicaid
FLAB758YMedicare PIN
FL3081800-00Medicaid
FLAB758XMedicare PIN