Provider Demographics
NPI:1619538527
Name:COPELAND, DOMINIQUE (APRN FNP)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9456 STATE HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6067
Mailing Address - Country:US
Mailing Address - Phone:972-942-0100
Mailing Address - Fax:
Practice Address - Street 1:9456 STATE HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6067
Practice Address - Country:US
Practice Address - Phone:972-942-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX882765163W00000X
TXAP143918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse