Healthcare Provider Details

I. General information

NPI: 1518942036
Provider Name (Legal Business Name): NANCY LEE KOPITNIK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 S TUTTLE AVE
SARASOTA FL
34239-2608
US

IV. Provider business mailing address

157 BALTIMORE ST STE 102
CUMBERLAND MD
21502-2472
US

V. Phone/Fax

Practice location:
  • Phone: 301-722-0484
  • Fax: 833-903-0130
Mailing address:
  • Phone: 301-722-0484
  • Fax: 833-903-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberOS6229
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS6229
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberOS6229
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS6229
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOS6229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: