MEDICARE: MRS. ANA LIZETT LOPEZ AGPCNP-BC

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	RN 9180599	FL
2	363LG0600X	Gerontology Nurse Practitioner	RN 9180599	FL

General Provider Information

NPI Number	:	1801238928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANA LIZETT LOPEZ AGPCNP-BC

Provider Business Mailing Address
First Line	:	3434 HANCOCK BRIDGE PKWY STE 301
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-7094
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

Provider Business Practice Location Address
First Line	:	4881 PALM BEACH BLVD
Second Line	:	STE 100
City	:	FORT MYERS
State	:	FL
Zip	:	33905-3217
Country	:	US
Telephone Number	:	239-693-9191
Fax Number	:	239-693-7369

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

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	04/22/2016

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