Provider Demographics
NPI:1023077690
Name:CAPUTO, COLETTE (PA C)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:CAPUTO
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NW 15TH ST STE 201A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1342
Mailing Address - Country:US
Mailing Address - Phone:561-368-4545
Mailing Address - Fax:561-368-4041
Practice Address - Street 1:1050 NW 15TH ST STE 201A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1342
Practice Address - Country:US
Practice Address - Phone:561-368-4545
Practice Address - Fax:561-368-4041
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291929000Medicaid
Q19610Medicare UPIN