MEDICARE: ELIZABETH DAWN CAPOTOSTI FNP

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	AP3574	AZ

General Provider Information

NPI Number	:	1851613780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH DAWN CAPOTOSTI FNP

Provider Business Mailing Address
First Line	:	3801 N CAMPBELL AVE
Second Line	:	STE B
City	:	TUCSON
State	:	AZ
Zip	:	85719-1448
Country	:	US
Telephone Number	:	520-777-4192
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 N CAMPBELL AVE
Second Line	:	STE B
City	:	TUCSON
State	:	AZ
Zip	:	85719-1448
Country	:	US
Telephone Number	:	520-777-4192
Fax Number	:

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

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	06/13/2012

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