Provider Demographics
NPI:1609890128
Name:CAMPERLENGO, NINA THEODORA (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:THEODORA
Last Name:CAMPERLENGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15511 N FLORIDA AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1220
Mailing Address - Country:US
Mailing Address - Phone:813-963-3124
Mailing Address - Fax:813-908-7808
Practice Address - Street 1:15511 N FLORIDA AVE STE 401
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1220
Practice Address - Country:US
Practice Address - Phone:813-963-3124
Practice Address - Fax:813-908-7808
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine