Provider Demographics
NPI:1134529886
Name:COPPOLA, CHRISTOPHER JOSS (RN)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOSS
Last Name:COPPOLA
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 1:4131 JUSTIN SCOTT LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:41044-9011
Mailing Address - Country:US
Mailing Address - Phone:606-375-3324
Mailing Address - Fax:
Practice Address - Street 1:4131 JUSTIN SCOTT LN
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:KY
Practice Address - Zip Code:41044-9011
Practice Address - Country:US
Practice Address - Phone:606-375-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-31
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-282018163W00000X
KY1133999163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse