Provider Demographics
NPI:1922876085
Name:GOMES XAVIER HOLLAND, CAMILLA
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:
Last Name:GOMES XAVIER HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAMILLA
Other - Middle Name:
Other - Last Name:GOMES XAVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4444 N FLAGLER DR UNIT 1802
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3985
Mailing Address - Country:US
Mailing Address - Phone:914-319-2437
Mailing Address - Fax:
Practice Address - Street 1:4444 N FLAGLER DR UNIT 1802
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3985
Practice Address - Country:US
Practice Address - Phone:914-319-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical