Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 11010627 | FL |
NPI | 1003402843 |
---|---|
Provider Name | Elizabeth Ann Campbell |
First Address | Jacksonville, FL 32246-8288 |
Second Address | Jacksonville, FL 32207-8202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2020 |
Last Update Date | 21/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11010627 | STATE BOARD OF NURSING (01) | FL |