Provider Demographics
NPI:1144459421
Name:CAMPBELL, ANNTOINETTE
Entity type:Individual
Prefix:MS
First Name:ANNTOINETTE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
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 54521
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-4521
Mailing Address - Country:US
Mailing Address - Phone:904-996-7587
Mailing Address - Fax:904-996-7591
Practice Address - Street 1:7555 BEACH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3003
Practice Address - Country:US
Practice Address - Phone:904-996-7587
Practice Address - Fax:904-996-7591
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693325496Medicaid
FL230925OtherMEDICARE LICENSE