Provider Demographics
NPI:1881840973
Name:CAPIZZI GARAND, JENNIFER ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:CAPIZZI GARAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 E FLORENCE BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4812
Mailing Address - Country:US
Mailing Address - Phone:520-876-0800
Mailing Address - Fax:520-876-0801
Practice Address - Street 1:1683 E FLORENCE BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4812
Practice Address - Country:US
Practice Address - Phone:520-876-0800
Practice Address - Fax:520-876-0801
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6252207Q00000X
OH50.001127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH074480Medicare PIN