Provider Demographics
NPI:1306337068
Name:LOPEZ, EDGARDO A (ARNP)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8181 NW 154TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5861
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:305-558-4316
Practice Address - Street 1:4700 SHERIDAN ST STE K
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3416
Practice Address - Country:US
Practice Address - Phone:954-966-7000
Practice Address - Fax:954-966-7095
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9333288363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner