Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 9215525 | FL |
NPI | 1275883100 |
---|---|
Provider Name | Melissa Kay Lopez |
First Address | Jacksonville, FL 32256-0532 |
Second Address | St Petersburg, FL 33701-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2012 |
Last Update Date | 11/03/2019 |