Provider Demographics
NPI:1811791130
Name:STALLWORTH, CAMELLA LATASHA (RN)
Entity type:Individual
Prefix:
First Name:CAMELLA
Middle Name:LATASHA
Last Name:STALLWORTH
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 RISING MIST LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-3006
Mailing Address - Country:US
Mailing Address - Phone:904-238-1796
Mailing Address - Fax:
Practice Address - Street 1:10245 RISING MIST LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-3006
Practice Address - Country:US
Practice Address - Phone:904-238-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9606414163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse