Healthcare Provider Details

I. General information

NPI: 1427021104
Provider Name (Legal Business Name): MERCEDES JENES COPELAND CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 HARRISON PKWY #200
SUNRISE FL
33323-2853
US

IV. Provider business mailing address

1274 NW 167TH AVE
PEMBROKE PINES FL
33028-1906
US

V. Phone/Fax

Practice location:
  • Phone: 954-838-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2966182
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4062090
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: