Provider Demographics
NPI:1568232346
Name:LOPEZ, ALYSSA CHRISTINE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CHRISTINE
Last Name:LOPEZ
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 1:2273 CARRIAGE POINTE LOOP
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-6512
Mailing Address - Country:US
Mailing Address - Phone:321-848-3317
Mailing Address - Fax:
Practice Address - Street 1:11600 LAKESIDE VILLAGE LN
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-7024
Practice Address - Country:US
Practice Address - Phone:407-876-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily