Provider Demographics
NPI:1093384943
Name:LOPEZ, JENNIFER THUY VI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THUY VI
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 FLINT ROCK CT
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2957
Mailing Address - Country:US
Mailing Address - Phone:317-225-3657
Mailing Address - Fax:
Practice Address - Street 1:605 E SAN ANTONIO ST STE 510E
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6011
Practice Address - Country:US
Practice Address - Phone:361-576-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045614363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care