Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | APRN11001977 | FL |
Y | 363L00000X | Nurse Practitioner | APRN11001977 | FL |
NPI | 1033708367 |
---|---|
Provider Name | Miss Jessica Danielle Copeland |
First Address | Clearwater, FL 33759-3012 |
Second Address | Tampa, FL 33607-6307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2021 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110112000 | (05) | FL |