Lopez, Jackeline

Lopez, Jackeline is an sole proprietor health care provider with primary practice located at 801 E Dixie Ave Ste 101 , Leesburg FL 34748-7601. She recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as her primary health care specialty. Lopez, Jackeline can be contacted via phone (352) 326-4031.

Contact Information

Primary practice address
801 E Dixie Ave Ste 101 Leesburg FL 34748-7601
Fax: (352) 360-0257
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 21359 Puerto Rico
Allopathic & Osteopathic Physicians / General Practice 208D00000X ACN1303 Florida

Profile Details

NPI number 1073174496
LBN Legal business name Lopez, Jackeline
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 26th, 2019
Last updated Jan 11th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073174496 NPPES
Florida MEDICAID 109164100

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