Provider Demographics
NPI:1093228298
Name:PEREZ HERNANDEZ, IVAN (ARNP)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:PEREZ HERNANDEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SW 62ND AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-669-7144
Mailing Address - Fax:305-663-8545
Practice Address - Street 1:3100 SW 62ND AVE STE 124
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-669-7144
Practice Address - Fax:305-663-8545
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9390645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily