Provider Demographics
NPI:1548356447
Name:COOPER, ANNIE G (FNP)
Entity type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:G
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WOODCREST RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1730
Mailing Address - Country:US
Mailing Address - Phone:718-477-6849
Mailing Address - Fax:718-240-0565
Practice Address - Street 1:2094 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3509
Practice Address - Country:US
Practice Address - Phone:718-240-0400
Practice Address - Fax:718-240-0565
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334265374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel