Provider Demographics
NPI:1982985099
Name:CAMP, NICOLA ANNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:NICOLA
Middle Name:ANNE
Last Name:CAMP
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32588
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-2588
Mailing Address - Country:US
Mailing Address - Phone:520-298-7883
Mailing Address - Fax:520-298-0035
Practice Address - Street 1:1200 N EL DORADO PL
Practice Address - Street 2:STE. A-150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4637
Practice Address - Country:US
Practice Address - Phone:520-298-7883
Practice Address - Fax:520-298-0035
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-12611225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0144070OtherBLUE CROSS