Healthcare Provider Details

I. General information

NPI: 1376265140
Provider Name (Legal Business Name): NEYLIN ESCANDON LOPEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 W 72ND PL
HIALEAH FL
33018-1712
US

IV. Provider business mailing address

3509 W 72ND PL
HIALEAH FL
33018-1712
US

V. Phone/Fax

Practice location:
  • Phone: 305-613-1846
  • Fax:
Mailing address:
  • Phone: 305-613-1846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11021581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: