Provider Demographics
NPI:1972147775
Name:LOPEZ PAMPIN, YUDELKA (APRN)
Entity Type:Individual
Prefix:
First Name:YUDELKA
Middle Name:
Last Name:LOPEZ PAMPIN
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 1:5575 S SEMORAN BLVD
Mailing Address - Street 2:STE 26
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1781
Mailing Address - Country:US
Mailing Address - Phone:407-401-8637
Mailing Address - Fax:407-401-8610
Practice Address - Street 1:1140 S SEMORAN BLVD STE E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1459
Practice Address - Country:US
Practice Address - Phone:407-384-9165
Practice Address - Fax:407-384-9174
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004224363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner