Healthcare Provider Details

I. General information

NPI: 1275527558
Provider Name (Legal Business Name): ANN CAROLYN LOPEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD
TAMPA FL
33612-4745
US

IV. Provider business mailing address

9309 HUNTINGTON PARK WAY
TAMPA FL
33647-2573
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax: 813-979-3642
Mailing address:
  • Phone: 813-973-2661
  • Fax: 813-979-3642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberARNP3127352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: