Provider Demographics
NPI:1063493021
Name:PEREZ, JODY LYNN (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LYNN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2218
Mailing Address - Country:US
Mailing Address - Phone:727-216-1420
Mailing Address - Fax:727-216-1418
Practice Address - Street 1:1900 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2218
Practice Address - Country:US
Practice Address - Phone:727-216-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000067A367A00000X
FLAPRN9454839367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN266180934OtherMEDICARE
IN200191180Medicaid