Provider Demographics
NPI:1528173010
Name:LOPEZ-NICHOLAS, DANETTE (ARNP C)
Entity type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:
Last Name:LOPEZ-NICHOLAS
Suffix:
Gender:F
Credentials:ARNP C
Other - Prefix:MRS
Other - First Name:DANETTE
Other - Middle Name:
Other - Last Name:LOPEZ-MONTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP C
Mailing Address - Street 1:1001 E OSCEOLA PKWY STE 3200
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1616
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:407-370-5820
Practice Address - Street 1:1001 E OSCEOLA PKWY STE 3200
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1616
Practice Address - Country:US
Practice Address - Phone:321-841-6444
Practice Address - Fax:407-370-5820
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9231152363LA2200X
FLARNP9231152207R00000X, 163W00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121783000Medicaid
FL307160000Medicaid
Q51884Medicare UPIN