Individual
CLIFFORD COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
110 LONGWOOD AVENUE, ROCKLEDGE, FL 32955-2828
(800) 476-8646
(919) 382-3210
Mailing address
PO BOX 30731, TAMPA, FL 33630-3731
(800) 476-8646
(919) 382-3210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9101412
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291562600
—
FL
Enumeration date
06/01/2005
Last updated
07/15/2008
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