Amy L. Coopersmith, FNP
Individual provider Active NPI Family Nurse Practitioner · Bunnell, FL
NPI 1083606503 · NPPES record last updated Dec 12, 2012
Key facts
- NPI
- 1083606503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 9242220 (FL)
- Practice address
- 301 Dr Carter Blvd
Bunnell, FL 32110-6212 - Phone
- (386) 437-7350
- NPI assigned
- Aug 19, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160426001492 | FL | Practitioner - Nurse Practitioner | 2961701982 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9242220 | FL | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 9242220 | FL | Yes |
Addresses
Primary practice location
301 Dr Carter Blvd
Bunnell, FL 32110-6212
Mailing address
51 Renworth LN
Palm Coast, FL 32164-6627
Phone (386) 586-5314
Other providers in Bunnell, FL
- Alice Chandler
- Valerie Jean Christie
- Clarke in-Home Senior Care LLC
- Daniel Dalton Cody
- Ashlee Coleman
- Susan E Crane
- Erin Stewart Crimmins
- Robert Aloysius Crimmins
- Nancy Hutt Culver
- Klara Dandrea
All providers in Bunnell, FL · Family Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.