Healthcare Provider Details

I. General information

NPI: 1215863782
Provider Name (Legal Business Name): CALEB COPEK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 SHADE TREE LN
CLEARWATER FL
33759-1332
US

IV. Provider business mailing address

2388 SHADE TREE LN
CLEARWATER FL
33759-1332
US

V. Phone/Fax

Practice location:
  • Phone: 727-366-8016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA1214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: