Provider Demographics
NPI:1871999508
Name:COOPER, BRENDA ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ANN
Last Name:COOPER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NW CORPORATE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7337
Mailing Address - Country:US
Mailing Address - Phone:561-499-6933
Mailing Address - Fax:561-235-5172
Practice Address - Street 1:1113 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5759
Practice Address - Country:US
Practice Address - Phone:561-201-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9175553363LF0000X
FLAPRN9175553363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL511613937916002Medicare Oscar/Certification