Provider Demographics
NPI:1174270128
Name:FLORES-LOPEZ, EDUARDO ALEJANDRO (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:ALEJANDRO
Last Name:FLORES-LOPEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1358
Mailing Address - Country:US
Mailing Address - Phone:817-332-7722
Mailing Address - Fax:817-582-4977
Practice Address - Street 1:1919 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1358
Practice Address - Country:US
Practice Address - Phone:817-332-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner