Provider Demographics
NPI:1578745998
Name:CAPOUCH, JUANITA (FNP)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:
Last Name:CAPOUCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N YARBROUGH DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-3240
Mailing Address - Country:US
Mailing Address - Phone:915-595-1844
Mailing Address - Fax:915-599-1953
Practice Address - Street 1:501 N YARBROUGH DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-3240
Practice Address - Country:US
Practice Address - Phone:915-595-1844
Practice Address - Fax:915-599-1953
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP115287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297636704Medicaid
TX130880104Medicaid
TX265175YLPSOtherWELLMED PTAN
TX265175YLPSOtherWELLMED PTAN