Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 11014498 | FL |
NPI | 1093482093 |
---|---|
Provider Name | Irving Joseph Campbell |
First Address | Boca Raton, FL 33431-8554 |
Second Address | Coral Springs, FL 33065-4108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2021 |
Last Update Date | 26/08/2021 |