Provider Demographics
NPI:1265921464
Name:CAMERON, KALYN V (APRN)
Entity type:Individual
Prefix:MISS
First Name:KALYN
Middle Name:V
Last Name:CAMERON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4706
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33677-4706
Mailing Address - Country:US
Mailing Address - Phone:813-280-0202
Mailing Address - Fax:813-280-0203
Practice Address - Street 1:26606 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-8545
Practice Address - Country:US
Practice Address - Phone:813-907-0123
Practice Address - Fax:813-907-5559
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9309406363L00000X
FLAPRN9309406363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101086500Medicaid