Provider Demographics
NPI:1811265572
Name:CAMPBELL, ANGELA MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BAY HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:PONCE INLET
Mailing Address - State:FL
Mailing Address - Zip Code:32127-7241
Mailing Address - Country:US
Mailing Address - Phone:386-231-6300
Mailing Address - Fax:
Practice Address - Street 1:58 BAY HARBOUR DR
Practice Address - Street 2:
Practice Address - City:PONCE INLET
Practice Address - State:FL
Practice Address - Zip Code:32127-7241
Practice Address - Country:US
Practice Address - Phone:386-231-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1558172363L00000X
WAN360751709363LF0000X
WAAP60748124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner