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Individual

STACI E LOPEZ-VERGARA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CPNP

Contact information

Practice address
9840 N BEACH ST, FORT WORTH, TX 76244-6184
(817) 431-3898
(817) 379-1161
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-1855
(682) 885-1396

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
755740
TX
363LP0200X
Pediatric Nurse Practitioner
Primary
AP122615
TX
363LP2300X
Primary Care Nurse Practitioner
AP122615
TX

Other

Enumeration date
12/04/2012
Last updated
05/14/2024
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