Provider Demographics
NPI:1801133855
Name:CAMPBELL, ANGELA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:CAMPBELL
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 1:1608 SE 3RD AVENUE
Mailing Address - Street 2:THIRD FLOOR PBO
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2564
Mailing Address - Country:US
Mailing Address - Phone:954-786-5901
Mailing Address - Fax:954-786-0129
Practice Address - Street 1:2011 NW 3 AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-4800
Practice Address - Country:US
Practice Address - Phone:954-786-5901
Practice Address - Fax:954-786-0129
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9169480363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010423100Medicaid