MEDICARE: MRS. JESSICA ELISE LOPEZ FNP-C

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	363LF0000X	Family Nurse Practitioner	312191	AZ

General Provider Information

NPI Number	:	1164268777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA ELISE LOPEZ FNP-C

Provider Business Mailing Address
First Line	:	5880 N LA CHOLLA BLVD STE 180
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3592
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5880 N LA CHOLLA BLVD STE 180
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3592
Country	:	US
Telephone Number	:	520-751-3695
Fax Number	:

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

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	01/03/2025

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