Healthcare Provider Details

I. General information

NPI: 1033703640
Provider Name (Legal Business Name): TIFFANY D LOPEZ MSN, CRNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 UPPER CHESAPEAKE DR STE 301
BEL AIR MD
21014-4375
US

IV. Provider business mailing address

520 UPPER CHESAPEAKE DR STE 301
BEL AIR MD
21014-4375
US

V. Phone/Fax

Practice location:
  • Phone: 443-643-4300
  • Fax:
Mailing address:
  • Phone: 443-643-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP022502
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP022502
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: