Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 251889 | NY |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 99923 | FL |
NPI | 1063623817 |
---|---|
Provider Name | Dr. Heather Jane Cappello |
First Address | Orlando, FL 32886-0001 |
Second Address | Sarasota, FL 34239-2939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002375700 | (05) | FL |
149PP | BCBS (01) | FL |
P00913627 | MEDICARE RR (01) | FL |