Individual
ANN-MARIE DOREEN COOPER-ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
396 SW RIDGECREST DR, PORT SAINT LUCIE, FL 34953-5917
(954) 200-2795
Mailing address
396 SW RIDGECREST DR, PORT SAINT LUCIE, FL 34953-5917
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
Primary
—
—
374U00000X
Home Health Aide
—
—
376K00000X
Nurse's Aide
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9542002795
TELEPHONE
—
Enumeration date
05/13/2020
Last updated
05/13/2020
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