Basic Information
Provider Information | |||||||||
NPI: | 1538425897 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CAMPO | ||||||||
FirstName: | ROWENA | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BUGARIN | ||||||||
OtherFirstName: | ROWENA | ||||||||
OtherMiddleName: | L | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CRNA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 817737 | ||||||||
Address2: |   | ||||||||
City: | HOLLYWOOD | ||||||||
State: | FL | ||||||||
PostalCode: | 330811737 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8004372672 | ||||||||
FaxNumber: | 9548511758 | ||||||||
Practice Location | |||||||||
Address1: | 8201 WEST BROWARD BOULEVARD | ||||||||
Address2: |   | ||||||||
City: | PLANTATION | ||||||||
State: | FL | ||||||||
PostalCode: | 333240000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9544763911 | ||||||||
FaxNumber: | 9544522185 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/11/2012 | ||||||||
LastUpdateDate: | 09/25/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP9220978 | FL | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.