MEDICARE: PENNY COOKE

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	106S00000X	Behavior Technician		VA

General Provider Information

NPI Number	:	1326996828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNY COOKE

Provider Business Mailing Address
First Line	:	350 FAIRWAY DR STE 101
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1834
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

Provider Business Practice Location Address
First Line	:	301 LYNNHAVEN PKWY STE 400
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7411
Country	:	US
Telephone Number	:	757-568-9036
Fax Number	:

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

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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Directions to “ PENNY COOKE ” Practice Location

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