Provider Demographics
NPI:1386888022
Name:CAPOCCIA, KRYSTYNA HALINA (RN, FNP)
Entity type:Individual
Prefix:MRS
First Name:KRYSTYNA
Middle Name:HALINA
Last Name:CAPOCCIA
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 KIMBER CT
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1331
Mailing Address - Country:US
Mailing Address - Phone:631-757-9131
Mailing Address - Fax:
Practice Address - Street 1:18 KIMBER CT
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1331
Practice Address - Country:US
Practice Address - Phone:631-757-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY510010-1163W00000X
NYF336253363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02384572Medicaid