Provider Demographics
NPI:1891402558
Name:CAMPBELL, JOSEPHINE ANTOINETTE (NP)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ANTOINETTE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9413 FLATLANDS AVE STE 101E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3713
Mailing Address - Country:US
Mailing Address - Phone:347-589-5213
Mailing Address - Fax:718-257-6615
Practice Address - Street 1:9413 FLATLANDS AVE STE 101E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3713
Practice Address - Country:US
Practice Address - Phone:718-257-6615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily