MEDICARE: MRS. MARIAN COPPO CHASE ARNP

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	363LA2200X	Adult Health Nurse Practitioner	ARNP 1035442	FL

General Provider Information

NPI Number	:	1134663933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIAN COPPO CHASE ARNP

Provider Business Mailing Address
First Line	:	813 SUWANEE CT
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-4582
Country	:	US
Telephone Number	:	407-539-2936
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 VASSAR ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4922
Country	:	US
Telephone Number	:	407-461-8744
Fax Number	:

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

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	12/13/2016

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