Healthcare Provider Details

I. General information

NPI: 1386182756
Provider Name (Legal Business Name): JENNIFER LOPEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9604 HOLLY POINT DR
HUNTERSVILLE NC
28078-4913
US

IV. Provider business mailing address

9604 HOLLY POINT DR
HUNTERSVILLE NC
28078-4913
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-5070
  • Fax: 704-316-5075
Mailing address:
  • Phone: 704-316-5070
  • Fax: 704-316-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009258
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009258
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: