Healthcare Provider Details

I. General information

NPI: 1588581011
Provider Name (Legal Business Name): JENNIFER COOPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 BABCOCK ST NE STE 303
PALM BAY FL
32905-4648
US

IV. Provider business mailing address

5200 BABCOCK ST NE STE 303
PALM BAY FL
32905-4648
US

V. Phone/Fax

Practice location:
  • Phone: 321-499-3077
  • Fax: 888-440-8238
Mailing address:
  • Phone: 321-499-3077
  • Fax: 888-440-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1106731
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: