Provider Demographics
NPI:1679171532
Name:DEL CAMPO, KIMBERLEE C
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:C
Last Name:DEL CAMPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:
Other - Last Name:RUSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:1200 S SEAGATE DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2227
Mailing Address - Country:US
Mailing Address - Phone:386-216-8397
Mailing Address - Fax:
Practice Address - Street 1:1590 S, STATE HIGHWAY 15A
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-774-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009536363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner