Provider Demographics
NPI:1437393717
Name:CAMPBELL, CHERYL L (ARNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4505
Mailing Address - Country:US
Mailing Address - Phone:863-293-2147
Mailing Address - Fax:863-294-2147
Practice Address - Street 1:1450 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4505
Practice Address - Country:US
Practice Address - Phone:855-353-7546
Practice Address - Fax:863-294-2767
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2958462363L00000X
FLAPRN2958462363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100202200Medicaid