Provider Demographics
NPI:1083381222
Name:PEREZ, JONATHAN (NP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E PALM DR APT 207
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3539
Mailing Address - Country:US
Mailing Address - Phone:787-314-5616
Mailing Address - Fax:
Practice Address - Street 1:625 E PALM DR APT 207
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-3539
Practice Address - Country:US
Practice Address - Phone:787-314-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily