Provider Demographics
NPI:1083606503
Name:COOPERSMITH, AMY L (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:COOPERSMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 RENWORTH LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6627
Mailing Address - Country:US
Mailing Address - Phone:386-586-5314
Mailing Address - Fax:
Practice Address - Street 1:301 DR CARTER BLVD
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-6212
Practice Address - Country:US
Practice Address - Phone:386-437-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9242220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily