Healthcare Provider Details

I. General information

NPI: 1588537526
Provider Name (Legal Business Name): GENESIS FELIZ-LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 REBECCA LN STE 107
ORANGE CITY FL
32763-8350
US

IV. Provider business mailing address

2725 REBECCA LN STE 107
ORANGE CITY FL
32763-8350
US

V. Phone/Fax

Practice location:
  • Phone: 386-775-0736
  • Fax: 386-775-0738
Mailing address:
  • Phone: 386-775-0736
  • Fax: 386-775-0738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11040649
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: