Provider Demographics
NPI:1225629280
Name:LERMA LOPEZ, JORGE A (ARNP)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:LERMA LOPEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 S MIAMI AVE STE 4002
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4231
Mailing Address - Country:US
Mailing Address - Phone:305-393-8810
Mailing Address - Fax:305-393-8811
Practice Address - Street 1:3659 S MIAMI AVE STE 4002
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4231
Practice Address - Country:US
Practice Address - Phone:305-393-8810
Practice Address - Fax:305-393-8811
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP11009788363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty