Provider Demographics
NPI:1659511962
Name:LOPEZ LARA, ESTRELLA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ESTRELLA
Middle Name:
Last Name:LOPEZ LARA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:ESTRELLA
Other - Middle Name:L
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:907 N PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-3107
Mailing Address - Country:US
Mailing Address - Phone:813-778-8643
Mailing Address - Fax:
Practice Address - Street 1:907 N PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-3107
Practice Address - Country:US
Practice Address - Phone:813-778-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2566422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01119619OtherRR MCR