Provider Demographics
NPI:1902317217
Name:CAMPBELL, ANTHONY D (FNP)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10325 BLOOMFIELD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-2547
Mailing Address - Country:US
Mailing Address - Phone:813-974-3251
Mailing Address - Fax:
Practice Address - Street 1:10325 BLOOMFIELD HILLS DR
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-2547
Practice Address - Country:US
Practice Address - Phone:813-974-3251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2859012363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily