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NPI Code Detail

MEDICARE: ANGELO JOSEPH CAPOBIANCO PA

MEDICARE:   ANGELO JOSEPH CAPOBIANCO  PA
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1508475559
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELO JOSEPH CAPOBIANCO PA
Provider Business Mailing Address
First Line : 8680 BAYMEADOWS RD E APT 1626
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-4007
Country : US
Telephone Number : 516-724-6020
Fax Number :
Provider Business Practice Location Address
First Line : 8823 SAN JOSE BLVD STE 209
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-4288
Country : US
Telephone Number : 516-724-6020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2020
Last Update Date : 07/27/2020

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Directions to “ ANGELO JOSEPH CAPOBIANCO PA” Practice Location

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