Healthcare Provider Details

I. General information

NPI: 1477538460
Provider Name (Legal Business Name): ROBERT NICHOLAS CAPOBIANCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/07/2023
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BUDINGER AVE STE 206
SAINT CLOUD FL
34769-4137
US

IV. Provider business mailing address

1330 BUDINGER AVE STE 108
SAINT CLOUD FL
34769-4137
US

V. Phone/Fax

Practice location:
  • Phone: 407-498-3763
  • Fax: 407-498-3793
Mailing address:
  • Phone: 407-498-3763
  • Fax: 407-498-3793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number78444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: