Provider Demographics
NPI:1326554825
Name:LOPEZ, MELISSA ANNE (ARNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221022
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33422-1022
Mailing Address - Country:US
Mailing Address - Phone:561-352-7953
Mailing Address - Fax:
Practice Address - Street 1:4152 W BLUE HERON BLVD STE 123
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4859
Practice Address - Country:US
Practice Address - Phone:561-844-7699
Practice Address - Fax:561-842-8261
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL17000232878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily