Provider Demographics
NPI:1952421406
Name:SMITH-CAMPBELL, SHIRLOW ANGELIQUE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLOW
Middle Name:ANGELIQUE
Last Name:SMITH-CAMPBELL
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12356 KIWI CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6219
Mailing Address - Country:US
Mailing Address - Phone:904-386-2437
Mailing Address - Fax:
Practice Address - Street 1:12356 KIWI CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6219
Practice Address - Country:US
Practice Address - Phone:904-386-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45675174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC4072OtherBSBSF