Provider Demographics
NPI:1427600030
Name:LOPEZ, GENESIS VIEYRA (DNP, AGACNP-BC)
Entity type:Individual
Prefix:DR
First Name:GENESIS
Middle Name:VIEYRA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC
Other - Prefix:
Other - First Name:GENESIS
Other - Middle Name:
Other - Last Name:VIEYRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:683 DOUGLAS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2555
Mailing Address - Country:US
Mailing Address - Phone:407-478-1510
Mailing Address - Fax:407-478-1512
Practice Address - Street 1:683 DOUGLAS AVE STE 101
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2555
Practice Address - Country:US
Practice Address - Phone:407-478-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9344025363LG0600X
FL9344025363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology