Provider Demographics
NPI:1306068275
Name:COPELAND, JIMMIE DEAN JR (LPN, LMT)
Entity type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:DEAN
Last Name:COPELAND
Suffix:JR
Gender:M
Credentials:LPN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351
Mailing Address - Country:US
Mailing Address - Phone:850-627-8591
Mailing Address - Fax:850-627-8277
Practice Address - Street 1:104 E. WASHINGTON STREET
Practice Address - Street 2:SUITE E.
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351
Practice Address - Country:US
Practice Address - Phone:850-627-8591
Practice Address - Fax:850-627-8277
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39911174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist