Provider Demographics
NPI:1013084375
Name:ROSA, MAGDA LOPEZ (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MAGDA
Middle Name:LOPEZ
Last Name:ROSA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 TURNSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8476
Mailing Address - Country:US
Mailing Address - Phone:407-922-0848
Mailing Address - Fax:
Practice Address - Street 1:10244 E COLONIAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4374
Practice Address - Country:US
Practice Address - Phone:321-235-5513
Practice Address - Fax:321-235-6125
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2709562363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health