Provider Demographics
NPI:1265915359
Name:MOBILE VISITING PRACTITIONERS, LLC
Entity type:Organization
Organization Name:MOBILE VISITING PRACTITIONERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-362-0627
Mailing Address - Street 1:140 S BEACH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4409
Mailing Address - Country:US
Mailing Address - Phone:888-506-8836
Mailing Address - Fax:888-506-8837
Practice Address - Street 1:140 S BEACH ST STE 202
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4409
Practice Address - Country:US
Practice Address - Phone:888-506-8836
Practice Address - Fax:888-506-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty