Individual
MRS. DEIRDRE ANN POPE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
9900 HIGHWAY 2301, YOUNGSTOWN, FL 32466-2444
(850) 722-1999
Mailing address
9900 HIGHWAY 2301, YOUNGSTOWN, FL 32466-2444
(850) 722-1999
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN2238592
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000342900
MEDICAID WAIVER
FL
Enumeration date
09/15/2010
Last updated
09/15/2010
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