Provider Demographics
NPI:1649994518
Name:LOPEZ, TANEICOLE MICHELLE (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:TANEICOLE
Middle Name:MICHELLE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 NEWCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3264
Mailing Address - Country:US
Mailing Address - Phone:678-515-6394
Mailing Address - Fax:
Practice Address - Street 1:910 NEWCROFT AVE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3264
Practice Address - Country:US
Practice Address - Phone:678-515-6394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily