Provider Demographics
NPI:1871053959
Name:COOPER-LYNN, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COOPER-LYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14311 BISCAYNE BLVD # 3862
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33261-3479
Mailing Address - Country:US
Mailing Address - Phone:954-440-5182
Mailing Address - Fax:888-410-2849
Practice Address - Street 1:3051 NW 151ST TER
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2543
Practice Address - Country:US
Practice Address - Phone:786-942-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-23
Last Update Date:2019-04-24
Deactivation Date:2019-03-23
Deactivation Code:
Reactivation Date:2019-04-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371910434OtherTAX ID