Provider Demographics
NPI:1194138586
Name:COOPER, MARY LYNN (NP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8687 SW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3703
Mailing Address - Country:US
Mailing Address - Phone:954-914-3356
Mailing Address - Fax:
Practice Address - Street 1:5701 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-1703
Practice Address - Country:US
Practice Address - Phone:954-518-7500
Practice Address - Fax:954-518-7501
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1944362363LG0600X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology