Provider Demographics
NPI:1881009843
Name:CAMPBELL, JIMMY REX JR
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:REX
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:REX
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:6469 GREENLAND CHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-9440
Mailing Address - Country:US
Mailing Address - Phone:678-234-5229
Mailing Address - Fax:
Practice Address - Street 1:6469 GREENLAND CHASE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-9440
Practice Address - Country:US
Practice Address - Phone:678-234-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9276226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily