Healthcare Provider Details

I. General information

NPI: 1710556857
Provider Name (Legal Business Name): PORSCHE COPPIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 12/29/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 OWEN DR
FAYETTEVILLE NC
28304-3432
US

IV. Provider business mailing address

522 OWEN DR
FAYETTEVILLE NC
28304-3432
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-7183
  • Fax:
Mailing address:
  • Phone: 910-484-7183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5015481
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number223540
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: