1588239347 NPI number — MRS. REBECCA LYNNE CAMPBELL FNP-BC

Table of content: MRS. REBECCA LYNNE CAMPBELL FNP-BC (NPI 1588239347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588239347 NPI number — MRS. REBECCA LYNNE CAMPBELL FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
REBECCA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALLAM
Provider Other First Name:
REBECCA
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588239347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10383 HAGEN RANCH RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33437-3782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-349-7653
Provider Business Mailing Address Fax Number:
561-739-5255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10383 HAGEN RANCH RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33437-3782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-349-7653
Provider Business Practice Location Address Fax Number:
561-739-5255
Provider Enumeration Date:
05/24/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN11013877 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 9464135 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111254400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".