Provider Demographics
NPI:1497473318
Name:CAPOBIANCO, TARA DANIELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:DANIELLE
Last Name:CAPOBIANCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 WATERMAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02827-1619
Mailing Address - Country:US
Mailing Address - Phone:401-603-9975
Mailing Address - Fax:
Practice Address - Street 1:153 WATERMAN HILL RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02827-1619
Practice Address - Country:US
Practice Address - Phone:401-603-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN60114163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine