Healthcare Provider Details

I. General information

NPI: 1003803909
Provider Name (Legal Business Name): CHRISTOPHER COPPOLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 36TH ST STE C
VERO BEACH FL
32960-4875
US

IV. Provider business mailing address

1600 36TH ST STE C
VERO BEACH FL
32960-4875
US

V. Phone/Fax

Practice location:
  • Phone: 772-217-4422
  • Fax: 772-217-4460
Mailing address:
  • Phone: 772-217-4422
  • Fax: 772-217-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS7719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: