Provider Demographics
NPI:1174298814
Name:PERILLO, KATHLEEN (APRN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PERILLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 LACERTA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9331
Mailing Address - Country:US
Mailing Address - Phone:321-689-3557
Mailing Address - Fax:
Practice Address - Street 1:1969 S ALAFAYA TRL STE 344
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8732
Practice Address - Country:US
Practice Address - Phone:321-689-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018438363LF0000X
NY348114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily