Individual provider Active NPI

Nyla Cooper, ARNP

  • Nurse Practitioner
  • Port Charlotte, FL
National Provider Identifier
1477071330
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP9233847 Issued in FL
Practice address
21216 Olean Blvd Ste 6
Port Charlotte, FL 33952-6722
Phone
(941) 624-4800
Fax
(941) 206-0048
NPI assigned
Aug 31, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 33615 TN
Nurse Practitioner 363L00000X ARNP9233847 FL Primary

Addresses

Primary practice location

21216 Olean Blvd Ste 6
Port Charlotte, FL 33952-6722

Mailing address

21216 Olean Blvd Ste 6
Port Charlotte, FL 33952-6722
Phone (941) 624-4800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, TN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171019002216 FL Practitioner - Nurse Practitioner 3971879834
I20230821003042 TN Practitioner - Nurse Practitioner 3971879834 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Wound Care Tennessee PLLCGroup PAC ID 8527394477, 19 clinicians

Practice addresses (Care Compare)

141 N McLean Blvd
Memphis, TN 38104-2693
Phone (201) 870-1194

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
33615TNMDPharmacist
ARNP9233847FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ipc Pac Healthcare Services of Tennessee PC Nurse Practitioner CurrentSince Aug 15, 2023 Accepting new patients
NV Pacs 2 LLC CurrentSince Aug 15, 2023 Accepting new patients
CS Pacs 3 Southeast, LLC CurrentSince Sep 9, 2024 Accepting new patients
Lenita Hanson MD PA CurrentSince Mar 11, 2019 Accepting new patients
Integrated Wound Care Tennessee PLLC CurrentSince Feb 12, 2025 Accepting new patients

Locations

21216 Olean Blvd
Ste 6
Pt Charlotte, FL 33952
Phone (941) 624-4800

492C Cedar Ln
Teaneck, NJ 07666
Phone (201) 357-5468

880 S Mohawk Dr
Erwin, TN 37650
Phone (423) 743-7669

141 N McLean Blvd
Memphis, TN 38104
Phone (901) 276-2020

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1477071330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21216 OLEAN BLVD STE 6",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526722",
            "telephone_number": "941-624-4800",
            "fax_number": "941-206-0048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21216 OLEAN BLVD STE 6",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526722",
            "telephone_number": "941-624-4800",
            "fax_number": "941-206-0048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "NYLA",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-31",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TN",
            "license": "33615",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9233847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.