Provider Demographics
NPI:1184193880
Name:PEREZ FERNANDEZ, ROBERT (APRN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PEREZ FERNANDEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14832 SW 180TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6275
Mailing Address - Country:US
Mailing Address - Phone:786-773-6220
Mailing Address - Fax:
Practice Address - Street 1:14832 SW 180TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-6275
Practice Address - Country:US
Practice Address - Phone:407-658-9687
Practice Address - Fax:407-286-4515
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF10181801OtherBOARDS