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General NPI Number Information
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NPI Number | 1841782505
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Entity Type | Individual
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Provider Name | DIORGI LOPEZ SURI APRN
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Gender | Male
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 2624 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-3609
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Country | US
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Telephone | 904-513-3240
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Fax |
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Provider Business Mailing Address
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Address Line | 6821 SOUTHPOINT DR N STE 107
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8026
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Country | US
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Telephone | 866-372-0308
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Fax | 877-460-4651
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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 | 11011948
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License Number State | FL
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