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General NPI Number Information
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NPI Number | 1639548621
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Entity Type | Organization
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Legal Business Name | CAPSTONE HEALTHCARE,L.L.C
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Dates
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Enumeration Date | 09/19/2015
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1001 GREAT OAKS DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-3124
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Country | US
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Telephone | 386-492-5635
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Fax | 386-246-7418
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Provider Business Mailing Address
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Address Line | 1001 GREAT OAKS DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-3124
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Country | US
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Telephone | 386-492-5635
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Fax | 386-246-7418
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Authorized Official
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Title or Position | MGR
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Name | MRS. ROSHANDA K IVEY
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Credential |
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Telephone | 386-334-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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