MEDICARE: MRS. MAGDA LOPEZ ROSA ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	2709562	FL

General Provider Information

NPI Number	:	1013084375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAGDA LOPEZ ROSA ARNP

Provider Business Mailing Address
First Line	:	313 TURNSTONE WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-8476
Country	:	US
Telephone Number	:	407-922-0848
Fax Number	:

Provider Business Practice Location Address
First Line	:	10244 E COLONIAL DR
Second Line	:	SUITE 204
City	:	ORLANDO
State	:	FL
Zip	:	32817-4374
Country	:	US
Telephone Number	:	321-235-5513
Fax Number	:	321-235-6125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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