Provider Demographics
NPI:1114235850
Name:POPE, DEIRDRE ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:ANN
Last Name:POPE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RIKI
Other - Middle Name:
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:9900 HIGHWAY 2301
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32466-2444
Mailing Address - Country:US
Mailing Address - Phone:850-722-1999
Mailing Address - Fax:
Practice Address - Street 1:9900 HIGHWAY 2301
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32466-2444
Practice Address - Country:US
Practice Address - Phone:850-722-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2238592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000342900OtherMEDICAID WAIVER