Provider Demographics
NPI:1760702872
Name:CAPPS, CHRISTINE L (RD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:L
Last Name:CAPPS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18013 LAUREL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5017
Mailing Address - Country:US
Mailing Address - Phone:239-470-0663
Mailing Address - Fax:239-368-6078
Practice Address - Street 1:18013 LAUREL VALLEY RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-5017
Practice Address - Country:US
Practice Address - Phone:239-470-0663
Practice Address - Fax:239-368-6078
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2237133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN007DOtherBCBS FL
FLN007DOtherBCBS FL
FLDZ178ZMedicare PIN