Provider Demographics
NPI:1700337904
Name:LUSTERIO, CAMILLE (ARNP)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:LUSTERIO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 CENTERGATE DR
Mailing Address - Street 2:APT 206
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7226
Mailing Address - Country:US
Mailing Address - Phone:813-391-4404
Mailing Address - Fax:
Practice Address - Street 1:2457 CENTERGATE DR
Practice Address - Street 2:APT 206
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7226
Practice Address - Country:US
Practice Address - Phone:813-391-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 93388221163W00000X
FLARNP9338221363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse