Provider Demographics
NPI:1841757879
Name:COOK, CAMILLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12431 ADVENTURE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7789
Mailing Address - Country:US
Mailing Address - Phone:614-975-4446
Mailing Address - Fax:
Practice Address - Street 1:12431 ADVENTURE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7789
Practice Address - Country:US
Practice Address - Phone:614-975-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00027056363LF0000X
FL11007637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily