Healthcare Provider Details

I. General information

NPI: 1497677611
Provider Name (Legal Business Name): CYNTHIA VALENZUELA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17622 BRIGHT WHEAT DR
LITHIA FL
33547-4908
US

IV. Provider business mailing address

17622 BRIGHT WHEAT DR
LITHIA FL
33547-4908
US

V. Phone/Fax

Practice location:
  • Phone: 813-263-2710
  • Fax:
Mailing address:
  • Phone: 813-263-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11046569
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: