Provider Demographics
NPI:1518147453
Name:CAPORINA, SUSAN SAMANTHA (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SAMANTHA
Last Name:CAPORINA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BANKS DR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-4780
Mailing Address - Country:US
Mailing Address - Phone:615-643-0918
Mailing Address - Fax:
Practice Address - Street 1:118 BIGGS RD
Practice Address - Street 2:
Practice Address - City:COTTONTOWN
Practice Address - State:TN
Practice Address - Zip Code:37048-4633
Practice Address - Country:US
Practice Address - Phone:615-285-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000070079164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse