Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | FL |
NPI | 1164927158 |
---|---|
Provider Name | Ms. Rosemarie Campbell |
First Address | Gibsonton, FL 33534-3909 |
Second Address | Tampa, FL 33613-4613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2018 |
Last Update Date | 29/03/2018 |