Provider Demographics
NPI:1710631809
Name:LOPEZ, NATHAN (DNP, CRNA, APRN)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DNP, CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 S DESOTO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-0001
Mailing Address - Country:US
Mailing Address - Phone:469-964-4618
Mailing Address - Fax:
Practice Address - Street 1:7702 S DESOTO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-0001
Practice Address - Country:US
Practice Address - Phone:469-964-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9401226163WC0200X
FLAPRN11019592367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine