Provider Demographics
NPI:1912769217
Name:LOPEZ, VANESSA ROSA (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ROSA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16413 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1754
Mailing Address - Country:US
Mailing Address - Phone:954-870-9533
Mailing Address - Fax:
Practice Address - Street 1:16413 NW 21ST ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1754
Practice Address - Country:US
Practice Address - Phone:954-870-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030435363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care