MEDICARE: MARGARET ANN CAPUCINI APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP00248	OH
2	363LF0000X	Family Nurse Practitioner	3874	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00762653	OTHER	OH	RRMC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P00254124	OTHER	OH	RRMC

General Provider Information

NPI Number	:	1255300539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET ANN CAPUCINI APRN

Provider Business Mailing Address
First Line	:	1624 MAIN STREET
Second Line	:	AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO
City	:	COLUMBIA
State	:	SC
Zip	:	29201
Country	:	US
Telephone Number	:	803-454-0365
Fax Number	:	803-404-6000

Provider Business Practice Location Address
First Line	:	698 FAIRVIEW RD
Second Line	:	LTC HEALTH SOLUTIONS
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29680-6708
Country	:	US
Telephone Number	:	401-770-1669
Fax Number	:	401-216-0606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	11/22/2016

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