Healthcare Provider Details

I. General information

NPI: 1013084375
Provider Name (Legal Business Name): MAGDA LOPEZ ROSA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10244 E COLONIAL DR SUITE 204
ORLANDO FL
32817-4374
US

IV. Provider business mailing address

313 TURNSTONE WAY
ORLANDO FL
32828-8476
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-5513
  • Fax: 321-235-6125
Mailing address:
  • Phone: 407-922-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2709562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: