Provider Demographics
NPI:1407088750
Name:TWO RIVERS FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:TWO RIVERS FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCESCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPRARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-622-5432
Mailing Address - Street 1:1231 S PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3956
Mailing Address - Country:US
Mailing Address - Phone:321-622-5432
Mailing Address - Fax:321-622-8329
Practice Address - Street 1:1231 S PATRICK DR
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3956
Practice Address - Country:US
Practice Address - Phone:321-622-5432
Practice Address - Fax:321-622-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCX547AMedicare PIN