| Entity Name: | SYLVIA D. CAMPBELL, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 29 Aug 1983 (41 years ago) |
| Document Number: | G57106 |
| FEI/EIN Number | 592316341 |
| Address: | 2516 W. Sunset Dr, Tampa, FL, 33629, US |
| Mail Address: | 2516 W. Sunset Dr, Tampa, FL, 33629, US |
| ZIP code: | 33629 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811206964 | 2010-10-06 | 2010-10-06 | 217 SOUTH MATANZAS AVENUE, TAMPA, FL, 336093010, US | 217 SOUTH MATANZAS AVENUE, TAMPA, FL, 336093010, US | |||||||||||||||||||||||||||||
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| Phone | +1 813-875-2655 |
| Fax | 8138721838 |
Authorized person
| Name | KARIN LYNN RAYMOND |
| Role | OFFICE ADMINISTRATOR |
| Phone | 8138752655 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME32624 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 30483 |
| Issuer | MEDICAID |
| Number | 067048100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Campbell Sylvia DDr. | Agent | 2516 W. Sunset Dr, Tampa, FL, 33629 |
| Name | Role | Address |
|---|---|---|
| Campbell Sylvia DDr. | President | 2516 W. Sunset Dr, Tampa, FL, 33629 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2021-12-13 | No data | No data |
| CANCEL ADM DISS/REV | 2006-10-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
