Provider Demographics
NPI:1164763603
Name:COCCA, IANTHE ANN (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:IANTHE
Middle Name:ANN
Last Name:COCCA
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:MISS
Other - First Name:IANTHE
Other - Middle Name:ANN
Other - Last Name:MOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 160094
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0094
Mailing Address - Country:US
Mailing Address - Phone:321-689-6002
Mailing Address - Fax:321-972-6169
Practice Address - Street 1:122 ROCKHILL DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7747
Practice Address - Country:US
Practice Address - Phone:407-302-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9169229163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009380400Medicaid