Healthcare Provider Details

I. General information

NPI: 1255300539
Provider Name (Legal Business Name): MARGARET ANN CAPUCINI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 FAIRVIEW RD LTC HEALTH SOLUTIONS
SIMPSONVILLE SC
29680-6708
US

IV. Provider business mailing address

1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 401-770-1669
  • Fax: 401-216-0606
Mailing address:
  • Phone: 803-454-0365
  • Fax: 803-404-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP00248
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3874
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: