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General NPI Number Information
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NPI Number | 1750103362
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Entity Type | Individual
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Provider Name | JENNIFER LYNN LOPEZ APRN
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Gender | Female
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Dates
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Enumeration Date | 10/26/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 811 STATE ROAD 206 E STE 3
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4869
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Country | US
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Telephone | 904-342-2989
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Fax | 904-824-6243
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Provider Business Mailing Address
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Address Line | PO BOX 3123
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-3123
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Country | US
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Telephone | 904-824-4990
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Fax | 904-824-2226
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11035987
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APRN11035987
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License Number State | FL
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