Provider Demographics
NPI:1013015858
Name:CAPOBIANCO, JILL (ARNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CAPOBIANCO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMPUS DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5892
Mailing Address - Country:US
Mailing Address - Phone:603-422-8208
Mailing Address - Fax:603-422-8219
Practice Address - Street 1:100 CAMPUS DR
Practice Address - Street 2:SUITE 12
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5892
Practice Address - Country:US
Practice Address - Phone:603-422-8208
Practice Address - Fax:603-422-8219
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH050227-23-03363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30342327Medicaid
Q33943Medicare UPIN
NH30342327Medicaid