Healthcare Provider Details

I. General information

NPI: 1528216207
Provider Name (Legal Business Name): DORI H COPELAND P.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DORI H HOLMSTROM

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 HILLVIEW ST
SARASOTA FL
34239-3605
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8383
  • Fax: 941-917-8930
Mailing address:
  • Phone: 941-917-8383
  • Fax: 941-917-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9101417
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: