Healthcare Provider Details

I. General information

NPI: 1689009953
Provider Name (Legal Business Name): ERNIE LOZA ALDACO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3779
US

IV. Provider business mailing address

520 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3779
US

V. Phone/Fax

Practice location:
  • Phone: 770-287-0290
  • Fax:
Mailing address:
  • Phone: 770-287-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP230991
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberRN230991
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN230991
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN230991
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: