Provider Demographics
NPI:1013252477
Name:COPHER, ADAM LEE (RN)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:LEE
Last Name:COPHER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 TIMBER CREEK CT S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-1945
Mailing Address - Country:US
Mailing Address - Phone:904-226-3494
Mailing Address - Fax:
Practice Address - Street 1:85 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2109
Practice Address - Country:US
Practice Address - Phone:904-259-2935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9336485163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse