Healthcare Provider Details

I. General information

NPI: 1760452502
Provider Name (Legal Business Name): SAMUEL JASON KAPNICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 AIRPORT BLVD STE 2000
PENSACOLA FL
32504-8615
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 561-622-3810
  • Fax: 561-743-6354
Mailing address:
  • Phone: 904-450-6014
  • Fax: 904-450-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME49489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: