Provider Demographics
NPI:1457343519
Name:CUOCO, PENELOPE ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:ANN
Last Name:CUOCO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N HIATUS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5213
Mailing Address - Country:US
Mailing Address - Phone:954-381-8989
Mailing Address - Fax:954-381-8950
Practice Address - Street 1:500 N HIATUS RD STE 201
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5213
Practice Address - Country:US
Practice Address - Phone:954-381-8989
Practice Address - Fax:954-381-8950
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1521692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ01182Medicare UPIN
FLU1526ZMedicare ID - Type Unspecified