Provider Demographics
NPI:1780169300
Name:LOPEZ, PERLA CORNELIO (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:PERLA
Middle Name:CORNELIO
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-7408
Mailing Address - Country:US
Mailing Address - Phone:903-363-7890
Mailing Address - Fax:
Practice Address - Street 1:2990 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-2149
Practice Address - Country:US
Practice Address - Phone:903-593-1892
Practice Address - Fax:903-592-3886
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139541363L00000X, 363LF0000X
TX824208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner