Provider Demographics
NPI:1942202684
Name:COOPER, LESLEY ALLEN (NP-C)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:ALLEN
Last Name:COOPER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:ALLEN
Other - Last Name:PRIEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 W PINELOCH AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6100
Mailing Address - Country:US
Mailing Address - Phone:407-852-2760
Mailing Address - Fax:321-843-6729
Practice Address - Street 1:102 W PINELOCH AVE STE 23
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6100
Practice Address - Country:US
Practice Address - Phone:407-852-2760
Practice Address - Fax:321-843-6729
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9325010363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily