Provider Demographics
NPI:1902525157
Name:LOPEZ, NICOLE DIMURO (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DIMURO
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 NW 56TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2729
Mailing Address - Country:US
Mailing Address - Phone:954-850-1257
Mailing Address - Fax:
Practice Address - Street 1:2230 VENETIAN CT STE 1
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-8727
Practice Address - Country:US
Practice Address - Phone:239-236-5448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021489363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health