Healthcare Provider Details

I. General information

NPI: 1841613999
Provider Name (Legal Business Name): TINA LOPEZ MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 12/02/2023
Certification Date: 12/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 BRACE RD STE 103
CHERRY HILL NJ
08034-3213
US

IV. Provider business mailing address

1 FEDERAL ST # 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-536-1515
  • Fax: 856-536-1983
Mailing address:
  • Phone: 848-288-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00483000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: