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General NPI Number Information
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NPI Number | 1205411998
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Entity Type | Individual
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Provider Name | HEATHER LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 03/14/2021
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 1110 CITRUS LN
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3682
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Country | US
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Telephone | 863-978-8737
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Fax | 614-350-5011
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Provider Business Mailing Address
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Address Line | 1025 MARGOT LN
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City | LAKE WALES
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State | FL
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Zip | 33853-2732
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Country | US
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Telephone | 863-488-6827
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Fax | 614-350-5011
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11012093
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License Number State | FL
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