Jacqueline Campbell

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

RN 9219448 Issued in FL

Practice address

3189 SW Fambrough St
Port Saint Lucie, FL 34953-4541

Phone

(772) 203-3026

NPI assigned

Feb 5, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423094400000",
    "number": "1619368180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3189 SW FAMBROUGH ST",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349534541",
            "telephone_number": "772-203-3026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3189 SW FAMBROUGH ST",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349534541",
            "telephone_number": "772-203-3026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "JACQUELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-05",
        "last_updated": "2015-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "RN 9219448",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN 9219448",
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "FL",
            "license": "RN 9219448",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "FL",
            "license": "RN 9219448",
            "primary": true
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "FL",
            "license": "RN 9219448",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher D Callicott
• Adianys Calzadilla Romero, RBT
• Camarda Speech & Language Group, LLC
• Britni Gail Camarda, M.A. CCC. SLP
• Cecille Campbell
• Mieka Alicia Campbell, LMT
• Peggy Campbell, NP
• Shekeila Shenae Campbell, MD
• Renilde C Campos, RPH
• William Campos Sr., RPH

• Case Manager/Care Coordinator in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Case Manager/Care Coordinator in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.