Healthcare Provider Details

I. General information

NPI: 1801288527
Provider Name (Legal Business Name): COPROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5987 112TH PL
LIVE OAK FL
32060-7270
US

IV. Provider business mailing address

5987 112TH PL
LIVE OAK FL
32060-7270
US

V. Phone/Fax

Practice location:
  • Phone: 386-697-1156
  • Fax: 352-271-4255
Mailing address:
  • Phone: 386-697-1156
  • Fax: 352-271-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: CHERYL A. OSGOOD
Title or Position: OWNER
Credential:
Phone: 386-697-1156