Healthcare Provider Details

I. General information

NPI: 1760958144
Provider Name (Legal Business Name): RAPHAEL JOSEPH LOPEZ ARNP FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 W BROWARD BLVD
PLANTATION FL
33324-2701
US

IV. Provider business mailing address

13847 NW 22ND CT
SUNRISE FL
33323-5306
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-6600
  • Fax:
Mailing address:
  • Phone: 954-604-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9348684
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9348684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: