Provider Demographics
NPI:1275859878
Name:COOPER, ANDREA L (RD LD/N)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:RD LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9033
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-9033
Mailing Address - Country:US
Mailing Address - Phone:772-223-4916
Mailing Address - Fax:772-223-2887
Practice Address - Street 1:3496 NW FEDERAL HWY
Practice Address - Street 2:STE F
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4441
Practice Address - Country:US
Practice Address - Phone:772-223-4916
Practice Address - Fax:772-223-2887
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4025133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist