Healthcare Provider Details

I. General information

NPI: 1194501924
Provider Name (Legal Business Name): PRISCILLA LOPEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON ST STE 500A
HOLLYWOOD FL
33021-8256
US

IV. Provider business mailing address

6100 SW 94TH PL
MIAMI FL
33173-1546
US

V. Phone/Fax

Practice location:
  • Phone: 954-989-4700
  • Fax: 954-989-4754
Mailing address:
  • Phone: 786-222-2139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: