MEDICARE: COOPER MENTAL HEALTH & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1063365468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOPER MENTAL HEALTH & WELLNESS

Provider Business Mailing Address
First Line	:	12703 SADDLE CLUB CIR APT 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-9688
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12703 SADDLE CLUB CIR APT 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-9688
Country	:	US
Telephone Number	:	614-915-1826
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	JARED COOPER
Credential	:	PMHNP
Telephone Number	:	614-915-1826

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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