Healthcare Provider Details

I. General information

NPI: 1801238928
Provider Name (Legal Business Name): ANA LIZETT LOPEZ AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 PALM BEACH BLVD STE 100
FORT MYERS FL
33905-3217
US

IV. Provider business mailing address

3434 HANCOCK BRIDGE PKWY STE 301
NORTH FORT MYERS FL
33903-7094
US

V. Phone/Fax

Practice location:
  • Phone: 239-693-9191
  • Fax: 239-693-7369
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN 9180599
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN 9180599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: