Provider Demographics
NPI:1730101510
Name:CAMP, COLLEEN (CRNA)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:CAMP
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491529
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1529
Mailing Address - Country:US
Mailing Address - Phone:716-913-9905
Mailing Address - Fax:866-339-1813
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:716-913-9905
Practice Address - Fax:866-339-1813
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285388367500000X
FLARNP9336391367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF22126Medicare PIN
R82542Medicare UPIN