Provider Demographics
NPI:1669143939
Name:DECAMBRE, NADINE ALISON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NADINE
Middle Name:ALISON
Last Name:DECAMBRE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5238 NW JAKE CT
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2717
Mailing Address - Country:US
Mailing Address - Phone:954-704-4606
Mailing Address - Fax:
Practice Address - Street 1:1954 SW GATLIN BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2722
Practice Address - Country:US
Practice Address - Phone:772-224-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist