Basic Information
| Provider Information | |||||||||
| NPI: | 1730414442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | TAMARA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2960 ROOSEVELT BLVD | ||||||||
| Address2: | FAMILY SERVICE CENTERS INC | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275310482 | ||||||||
| FaxNumber: | 7275367867 | ||||||||
| Practice Location | |||||||||
| Address1: | 928 22ND AVE S | ||||||||
| Address2: | WESLEY W JENKINS COMMUNITY CENTER | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278223961 | ||||||||
| FaxNumber: | 7278230544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2009 | ||||||||
| LastUpdateDate: | 10/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.