Provider Demographics
NPI:1093012098
Name:LOPEZ, GLENDA YVONNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:YVONNE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 LEISURE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-5425
Mailing Address - Country:US
Mailing Address - Phone:407-421-2534
Mailing Address - Fax:
Practice Address - Street 1:2000 LEISURE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-5425
Practice Address - Country:US
Practice Address - Phone:407-421-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9300335163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse