MEDICARE: MRS. ORJANETTE MARIE COOPER-BRYANT APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN 3079412	FL
2	363LF0000X	Family Nurse Practitioner	APRN11004004	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013034388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ORJANETTE MARIE COOPER-BRYANT APRN

Provider Business Mailing Address
First Line	:	60 MEMORIAL MEDICAL PKWY
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5980
Country	:	US
Telephone Number	:	386-447-5989
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 N BEACH ST STE C
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5656
Country	:	US
Telephone Number	:	386-506-9994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	03/22/2021

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