Provider Demographics
NPI:1558510289
Name:COOPER-SLIFKO, JANA L (NP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:L
Last Name:COOPER-SLIFKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:L
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-0553
Mailing Address - Fax:
Practice Address - Street 1:4 COULTER RD STE 2605
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:315-462-2636
Practice Address - Fax:315-462-2638
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335550-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400019451Medicare PIN