Provider Demographics
NPI:1043798176
Name:LOPEZ BOUDET, AILETTE MARIA (FNPBC)
Entity Type:Individual
Prefix:
First Name:AILETTE
Middle Name:MARIA
Last Name:LOPEZ BOUDET
Suffix:
Gender:F
Credentials:FNPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9365 FONTAINEBLEAU BLVD APT E201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4643
Mailing Address - Country:US
Mailing Address - Phone:786-518-5468
Mailing Address - Fax:
Practice Address - Street 1:9365 FONTAINEBLEAU BLVD APT E201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4643
Practice Address - Country:US
Practice Address - Phone:786-518-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9400356207Q00000X
FLAPRN9400356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine