Provider Demographics
NPI:1255300539
Name:CAPUCINI, MARGARET ANN (APRN)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:CAPUCINI
Suffix:
Gender:F
Credentials:APRN
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1624 MAIN STREET
Mailing Address - Street 2:AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-454-0365
Mailing Address - Fax:803-404-6000
Practice Address - Street 1:698 FAIRVIEW RD
Practice Address - Street 2:LTC HEALTH SOLUTIONS
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6708
Practice Address - Country:US
Practice Address - Phone:401-770-1669
Practice Address - Fax:401-216-0606
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHNP00248363LF0000X
SC3874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00762653OtherRRMC
OH2348516Medicaid
OHP00254124OtherRRMC
OHP00254124OtherRRMC
OHP00254124OtherRRMC
OH2348516Medicaid