Individual
JERADINE CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
345 GREEN ST, MONTICELLO, FL 32344-2146
(850) 274-3360
Mailing address
345 GREEN ST, MONTICELLO, FL 32344-2146
(850) 274-3360
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
CNA99144
FL
376K00000X
Nurse's Aide
CNA99144
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105244100
—
FL
Enumeration date
02/26/2021
Last updated
02/26/2021
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