Provider Demographics
NPI:1508475559
Name:CAPOBIANCO, ANGELO JOSEPH (PA)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:JOSEPH
Last Name:CAPOBIANCO
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 1:8680 BAYMEADOWS RD E APT 1626
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4007
Mailing Address - Country:US
Mailing Address - Phone:516-724-6020
Mailing Address - Fax:
Practice Address - Street 1:8823 SAN JOSE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4288
Practice Address - Country:US
Practice Address - Phone:516-724-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant