Provider Demographics
NPI:1043627748
Name:PEREZ, MARY MELISSA
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MELISSA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10475 MELANIE AVE
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-3707
Mailing Address - Country:US
Mailing Address - Phone:352-398-3153
Mailing Address - Fax:
Practice Address - Street 1:10475 MELANIE AVE
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-3707
Practice Address - Country:US
Practice Address - Phone:352-398-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 220320374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide