MEDICARE: MRS. RITA MARIE LOPEZ APRN

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	363LA2200X	Adult Health Nurse Practitioner	28853	MT
2	363LF0000X	Family Nurse Practitioner	1433822	FL

General Provider Information

NPI Number	:	1447433107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RITA MARIE LOPEZ APRN

Provider Business Mailing Address
First Line	:	15932 E HIGHWAY 40
Second Line	:
City	:	SILVER SPRINGS
State	:	FL
Zip	:	34488-5144
Country	:	US
Telephone Number	:	406-625-7777
Fax Number	:	352-625-1970

Provider Business Practice Location Address
First Line	:	15932 E HIGHWAY 40
Second Line	:
City	:	SILVER SPRINGS
State	:	FL
Zip	:	34488-5144
Country	:	US
Telephone Number	:	406-625-7777
Fax Number	:	352-625-1970

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

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	01/15/2019

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