Provider Demographics
NPI:1386245959
Name:SUAREZ LOPEZ, JERLYS (FNP)
Entity type:Individual
Prefix:
First Name:JERLYS
Middle Name:
Last Name:SUAREZ LOPEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 COACHMAKER TRL
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-1530
Mailing Address - Country:US
Mailing Address - Phone:832-996-6911
Mailing Address - Fax:
Practice Address - Street 1:3810 N. FRY , STE. 118
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77084
Practice Address - Country:US
Practice Address - Phone:832-321-4233
Practice Address - Fax:832-321-4310
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily