Provider Demographics
NPI:1083857809
Name:KOO, BIBI S (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BIBI
Middle Name:S
Last Name:KOO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:BIBI
Other - Middle Name:S
Other - Last Name:KOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33575-0906
Mailing Address - Country:US
Mailing Address - Phone:727-744-7995
Mailing Address - Fax:
Practice Address - Street 1:6240 N DURANGO DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3941
Practice Address - Country:US
Practice Address - Phone:954-923-7440
Practice Address - Fax:844-209-2827
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3183022363L00000X, 363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1083857809Medicare PIN