Healthcare Provider Details

I. General information

NPI: 1720088990
Provider Name (Legal Business Name): JO ANN L COOK EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 PALMETTO AVE
WINTER PARK FL
32789-4916
US

IV. Provider business mailing address

1316 PALMETTO AVE
WINTER PARK FL
32789-4916
US

V. Phone/Fax

Practice location:
  • Phone: 407-740-5259
  • Fax: 407-628-3933
Mailing address:
  • Phone: 407-740-5259
  • Fax: 407-628-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: