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NPI Code Detail

MEDICARE: ATHALIA LEEANNA LOPEZ RN

MEDICARE: ATHALIA LEEANNA LOPEZ RN
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
1163W00000XRegistered NurseRN9563724FL

General Provider Information

NPI Number : 1497619324
Entity Type Code : Individual
Provider Name (Legal Business Name) : ATHALIA LEEANNA LOPEZ RN
Provider Business Mailing Address
First Line : 4723 BERNARD BLVD
Second Line :
City : HAINES CITY
State : FL
Zip : 33844-6530
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4723 BERNARD BLVD
Second Line :
City : HAINES CITY
State : FL
Zip : 33844-6530
Country : US
Telephone Number : 617-935-4227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2025
Last Update Date : 12/15/2025

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