Healthcare Provider Details

I. General information

NPI: 1093418394
Provider Name (Legal Business Name): ALBERTO GUTIERREZ LOPEZ ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24301 WALDEN CENTER DR STE 103
BONITA SPRINGS FL
34134-4965
US

IV. Provider business mailing address

3236 FORUM BLVD
FORT MYERS FL
33905-5582
US

V. Phone/Fax

Practice location:
  • Phone: 239-445-3683
  • Fax: 239-829-9121
Mailing address:
  • Phone: 239-327-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11025194
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11025194
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: