Healthcare Provider Details

I. General information

NPI: 1790653889
Provider Name (Legal Business Name): CORAL LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 34TH AVE STE 701
OCALA FL
34474-8443
US

IV. Provider business mailing address

2316 POWELL CIR
SARASOTA FL
34234-6341
US

V. Phone/Fax

Practice location:
  • Phone: 877-779-2429
  • Fax: 882-484-4348
Mailing address:
  • Phone: 941-580-8398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11042816
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: