Provider Demographics
NPI:1649204124
Name:COOPER, SUSAN MARTHA (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARTHA
Last Name:COOPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SE 17TH ST
Mailing Address - Street 2:#309-128
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4421
Mailing Address - Country:US
Mailing Address - Phone:352-680-9243
Mailing Address - Fax:
Practice Address - Street 1:1801 SE 32ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5532
Practice Address - Country:US
Practice Address - Phone:352-629-0137
Practice Address - Fax:352-694-4824
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3000962163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory