Provider Demographics
NPI:1790798320
Name:KAPETANOS, NICOLE (RPA-C)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:KAPETANOS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 230TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2444
Mailing Address - Country:US
Mailing Address - Phone:718-224-7600
Mailing Address - Fax:
Practice Address - Street 1:1967 TURNBULL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2519
Practice Address - Country:US
Practice Address - Phone:718-792-4425
Practice Address - Fax:718-792-4096
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008268-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical