Provider Demographics
NPI:1114578325
Name:LOPEZ, MARIENELLI (RN)
Entity Type:Individual
Prefix:
First Name:MARIENELLI
Middle Name:
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 1:1831 BROCKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1831 BROCKRIDGE RD
Practice Address - Street 2:
Practice Address - City:KINDRED
Practice Address - State:FL
Practice Address - Zip Code:34744-6069
Practice Address - Country:US
Practice Address - Phone:407-399-0524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9465232163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse