MEDICARE: EDGLIS LOPEZ SOTOLONGO 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	363LF0000X	Family Nurse Practitioner	11000084	FL
2	103K00000X	Behavior Analyst	1-24-74918	FL
3	363LF0000X	Family Nurse Practitioner	APRN11000084	FL

General Provider Information

NPI Number	:	1851860548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGLIS LOPEZ SOTOLONGO APRN

Provider Business Mailing Address
First Line	:	6822 W 2ND CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-5302
Country	:	US
Telephone Number	:	786-609-1910
Fax Number	:

Provider Business Practice Location Address
First Line	:	3448 NW 79TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147-4602
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:

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

Provider Enumeration Date	:	11/25/2018
Last Update Date	:	09/17/2024

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