Provider Demographics
NPI:1922354000
Name:CAPO, GLENN ARTHUR (RN)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:ARTHUR
Last Name:CAPO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23154 AMBASSADOR AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-3540
Mailing Address - Country:US
Mailing Address - Phone:941-204-1992
Mailing Address - Fax:
Practice Address - Street 1:23154 AMBASSADOR AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-3540
Practice Address - Country:US
Practice Address - Phone:941-204-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK34607163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse