Healthcare Provider Details

I. General information

NPI: 1679406573
Provider Name (Legal Business Name): MARIANN LISA LOPEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SE MAGNOLIA EXT STE 204
OCALA FL
34471-4461
US

IV. Provider business mailing address

1500 SE MAGNOLIA EXT STE 204
OCALA FL
34471-4461
US

V. Phone/Fax

Practice location:
  • Phone: 352-789-5047
  • Fax: 352-574-6424
Mailing address:
  • Phone: 352-789-5047
  • Fax: 352-574-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11048176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: