Provider Demographics
NPI:1356764369
Name:MINUS, CAMILLA
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:
Last Name:MINUS
Suffix:
Gender:F
Credentials:
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 651521
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32965-1521
Mailing Address - Country:US
Mailing Address - Phone:772-205-7028
Mailing Address - Fax:
Practice Address - Street 1:5112 LA SALLE ST APT A
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-5035
Practice Address - Country:US
Practice Address - Phone:772-205-7028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA1248303747P1801X, 376K00000X
172V00000X, 374U00000X
FLRN9178180163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No163WH0200XNursing Service ProvidersRegistered NurseHome Health