Healthcare Provider Details

I. General information

NPI: 1265357024
Provider Name (Legal Business Name): MRS. NANCY LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12629 SHETLAND WALK DR
LITHIA FL
33547-3309
US

IV. Provider business mailing address

12629 SHETLAND WALK DR
LITHIA FL
33547-3309
US

V. Phone/Fax

Practice location:
  • Phone: 727-509-2916
  • Fax:
Mailing address:
  • Phone: 727-509-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: