MEDICARE: KATY G LOPEZ PAZ

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	207Q00000X	Family Medicine Physician	APRN11041910	FL
2	363LF0000X	Family Nurse Practitioner	APRN11041910	FL

General Provider Information

NPI Number	:	1417836347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATY G LOPEZ PAZ

Provider Business Mailing Address
First Line	:	330 CORPORATE WAY STE 200
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-6214
Country	:	US
Telephone Number	:	904-282-6331
Fax Number	:	904-866-4818

Provider Business Practice Location Address
First Line	:	421 KINGSLEY AVE STE 300
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4898
Country	:	US
Telephone Number	:	904-621-0643
Fax Number	:	833-576-2330

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

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	06/18/2026

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Directions to “ KATY G LOPEZ PAZ ” Practice Location

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