Provider Demographics
NPI:1528101151
Name:CAPOZZI, CAROL A (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:CAPOZZI
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 1:2090 N SMOKETREE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403
Mailing Address - Country:US
Mailing Address - Phone:928-854-1800
Mailing Address - Fax:928-854-1818
Practice Address - Street 1:2090 N SMOKETREE AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-854-1800
Practice Address - Fax:928-854-1818
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicare ID - Type Unspecified
FLP84151Medicare UPIN