Provider Demographics
NPI:1093482093
Name:CAMPBELL, IRVING JOSEPH (APRN)
Entity type:Individual
Prefix:
First Name:IRVING
Middle Name:JOSEPH
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:APRN
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 4189
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-4189
Mailing Address - Country:US
Mailing Address - Phone:954-363-9582
Mailing Address - Fax:954-363-9663
Practice Address - Street 1:1485 GATEWAY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8313
Practice Address - Country:US
Practice Address - Phone:561-231-6999
Practice Address - Fax:561-231-9696
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11014498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125227000Medicaid