Provider Demographics
NPI:1265435705
Name:CAPAN, JAY PATRICE (RN, PHCNS-BC)
Entity type:Individual
Prefix:MRS
First Name:JAY
Middle Name:PATRICE
Last Name:CAPAN
Suffix:
Gender:F
Credentials:RN, PHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 S I-35 E
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6800
Mailing Address - Country:US
Mailing Address - Phone:940-381-2313
Mailing Address - Fax:
Practice Address - Street 1:3537 S I-35 E
Practice Address - Street 2:SUITE 210
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6800
Practice Address - Country:US
Practice Address - Phone:940-381-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242271364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120096607Medicaid
TX120096607Medicaid
TX8D1305Medicare ID - Type Unspecified