Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | OS6229 | FL |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS6229 | FL |
N | 207RA0401X | Internist - Addiction Medicine | OS6229 | FL |
Y | 208D00000X | General Practice Physician | OS6229 | FL |
NPI | 1518942036 |
---|---|
Provider Name | Nancy Lee Kopitnik |
First Address | Orlando, FL 32822-8223 |
Second Address | Winter Park, FL 32792-6724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 10/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C78637 | (02) | FL |