Provider Demographics
NPI:1275720617
Name:VAN DE CAPPELLE, PAMELA MJ (APRN-BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MJ
Last Name:VAN DE CAPPELLE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MJ
Other - Last Name:RUTLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:2506 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-3846
Mailing Address - Country:US
Mailing Address - Phone:727-935-1050
Mailing Address - Fax:727-446-0999
Practice Address - Street 1:1103 CROYDON LN
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-5161
Practice Address - Country:US
Practice Address - Phone:863-326-2964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014779363LF0000X
FL651616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTRN22639OtherSTATE OF MONTANA LICENSE