Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP3256922 | FL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | NP3256922 | FL |
NPI | 1003884453 |
---|---|
Provider Name | Lino Lopez |
First Address | Eustis, FL 32736-8741 |
Second Address | Leesburg, FL 34748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 15/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ARNP3256922 | PROFESSIONAL LICENSE (01) | FL |
P00295594 | RR MCR (01) | |
Q51528 | (02) | FL |