Provider Demographics
NPI:1477071330
Name:COOPER, NYLA (ARNP)
Entity Type:Individual
Prefix:
First Name:NYLA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21216 OLEAN BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6722
Mailing Address - Country:US
Mailing Address - Phone:941-624-4800
Mailing Address - Fax:941-206-0048
Practice Address - Street 1:21216 OLEAN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6722
Practice Address - Country:US
Practice Address - Phone:941-624-4800
Practice Address - Fax:941-206-0048
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN33615363LG0600X
FLARNP9233847363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology