Healthcare Provider Details

I. General information

NPI: 1588441083
Provider Name (Legal Business Name): JESSICA CAPOZZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RICHLAND MEDICAL PARK DR STE 410
COLUMBIA SC
29203-6878
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4 FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-8740
  • Fax: 803-434-8749
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number30396
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: