Provider Demographics
NPI:1477137792
Name:CAPRIO, NICHOLAS ANGELO (PA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ANGELO
Last Name:CAPRIO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 SW SABLEWOOD CV
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2326
Mailing Address - Country:US
Mailing Address - Phone:772-618-5432
Mailing Address - Fax:
Practice Address - Street 1:433 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2573
Practice Address - Country:US
Practice Address - Phone:772-276-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114414363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty