Provider Demographics
NPI:1760170393
Name:AMANDA CAMP
Entity Type:Organization
Organization Name:AMANDA CAMP
Other - Org Name:COMPLETE INTEGRATIVE MEDICAL CLINIC, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DNPNPC
Authorized Official - Phone:813-374-5584
Mailing Address - Street 1:2835 W DE LEON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4130
Mailing Address - Country:US
Mailing Address - Phone:727-428-6344
Mailing Address - Fax:813-350-0703
Practice Address - Street 1:2835 W DE LEON ST STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4130
Practice Address - Country:US
Practice Address - Phone:727-428-6344
Practice Address - Fax:813-350-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty