Provider Demographics
NPI:1659731982
Name:LOPEZ-ROSA, GISELLE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:LOPEZ-ROSA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:GISELLE
Other - Middle Name:
Other - Last Name:LOPEZ-ROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:831 SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5328
Mailing Address - Country:US
Mailing Address - Phone:407-483-5757
Mailing Address - Fax:
Practice Address - Street 1:3115 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6501
Practice Address - Country:US
Practice Address - Phone:407-892-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1100218363LF0000X
FL11000218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102465100Medicaid