Provider Demographics
NPI:1184913535
Name:CAMPBELL, GINA L (ANP-C)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:L
Other - Last Name:FREER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 HIGHWAY 97 E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026-1517
Mailing Address - Country:US
Mailing Address - Phone:830-569-8147
Mailing Address - Fax:
Practice Address - Street 1:1901 HIGHWAY 97 E
Practice Address - Street 2:SUITE 200
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1517
Practice Address - Country:US
Practice Address - Phone:830-569-8147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630023363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health