Provider Demographics
NPI:1003884453
Name:LOPEZ, LINO (NP)
Entity Type:Individual
Prefix:
First Name:LINO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100222
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0222
Mailing Address - Country:US
Mailing Address - Phone:352-392-4321
Mailing Address - Fax:
Practice Address - Street 1:550 E. DIXIE AVENUE
Practice Address - Street 2:LRMC URGENT CARE
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-323-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3256922363L00000X
FLNP3256922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3256922OtherPROFESSIONAL LICENSE
P00295594OtherRR MCR
P00295594OtherRR MCR
FLU5826SMedicare PIN
FLU5826Medicare ID - Type UnspecifiedMEDICARE
FLQ51528Medicare UPIN