Provider Demographics
NPI:1619447737
Name:LEYVA LOPEZ, AIMEE (APRN)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:LEYVA LOPEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 W 60TH PL APT 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5954
Mailing Address - Country:US
Mailing Address - Phone:786-376-5554
Mailing Address - Fax:786-396-1466
Practice Address - Street 1:1821 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2419
Practice Address - Country:US
Practice Address - Phone:786-376-5554
Practice Address - Fax:786-396-1466
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-01
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11000115OtherAPRN