Provider Demographics
NPI:1194446195
Name:LOPEZ-ZUNIGA, BRISCILLA GHICELA
Entity type:Individual
Prefix:
First Name:BRISCILLA
Middle Name:GHICELA
Last Name:LOPEZ-ZUNIGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 W 61ST PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6317
Mailing Address - Country:US
Mailing Address - Phone:786-227-2408
Mailing Address - Fax:
Practice Address - Street 1:1380 W 61ST PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6317
Practice Address - Country:US
Practice Address - Phone:786-227-2408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019698363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner