Provider Demographics
NPI:1538562061
Name:LOPEZ, TAINA R (FNP)
Entity type:Individual
Prefix:
First Name:TAINA
Middle Name:R
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 W BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4015
Mailing Address - Country:US
Mailing Address - Phone:718-716-4400
Mailing Address - Fax:718-294-6912
Practice Address - Street 1:85 W BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4015
Practice Address - Country:US
Practice Address - Phone:718-716-4400
Practice Address - Fax:718-294-6912
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339050-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331943Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY00695941Medicaid
NY331043Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331944Medicare Oscar/Certification