Provider Demographics
NPI:1346054418
Name:COOPER, PEGGY F (CNA)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:F
Last Name:COOPER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181543
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32718-1543
Mailing Address - Country:US
Mailing Address - Phone:407-486-7395
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 181543
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32718-1543
Practice Address - Country:US
Practice Address - Phone:407-486-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA378450251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health