Provider Demographics
NPI:1740747047
Name:PACE, CAMILLA DAWN (FNP)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:DAWN
Last Name:PACE
Suffix:
Gender:F
Credentials:FNP
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 1092
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-1092
Mailing Address - Country:US
Mailing Address - Phone:352-354-5337
Mailing Address - Fax:
Practice Address - Street 1:4225 NW AMERICAN LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8841
Practice Address - Country:US
Practice Address - Phone:386-758-6141
Practice Address - Fax:386-758-6140
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily