Individual
ELIZABETH J LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4048 EVANS AVE, STE 303, FORT MYERS, FL 33901-9322
(239) 332-5344
(239) 332-7246
Mailing address
851 TRAFALGAR CT, MAITLAND, FL 32751-4132
(407) 667-0444
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
9285533
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000818700
—
FL
01
—
104935120
MICHIGAN MEDICAID
MI
05
—
2693269
—
OH
01
—
G4764
BCBS
FL
01
—
P00811906
MEDICARE RAILROAD
FL
Enumeration date
10/17/2006
Last updated
04/30/2021
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