Provider Demographics
NPI:1740601731
Name:PEACE OF MIND INTERNAL MEDICINE PLLC JENNIFER A COOKE SOLE MBR
Entity type:Organization
Organization Name:PEACE OF MIND INTERNAL MEDICINE PLLC JENNIFER A COOKE SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-255-8898
Mailing Address - Street 1:1675 TAMIAMI TRL
Mailing Address - Street 2:STE 5
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1042
Mailing Address - Country:US
Mailing Address - Phone:941-255-8898
Mailing Address - Fax:941-629-1969
Practice Address - Street 1:1675 TAMIAMI TRL
Practice Address - Street 2:STE 5
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1042
Practice Address - Country:US
Practice Address - Phone:941-255-8898
Practice Address - Fax:941-629-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OS11054OtherSTATE LICENSE