Provider Demographics
NPI:1114755840
Name:CAPISTRANO, STACI L (APRN-C)
Entity type:Individual
Prefix:MRS
First Name:STACI
Middle Name:L
Last Name:CAPISTRANO
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2169 SNAPDRAGON DR NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7205
Mailing Address - Country:US
Mailing Address - Phone:609-271-2351
Mailing Address - Fax:
Practice Address - Street 1:2169 SNAPDRAGON DR NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-7205
Practice Address - Country:US
Practice Address - Phone:609-271-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034041363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner