Provider Demographics
NPI:1235980921
Name:PEREZ, MAYRA (ARNP)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4598 CONWAY LANDING DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-8116
Mailing Address - Country:US
Mailing Address - Phone:786-817-9050
Mailing Address - Fax:
Practice Address - Street 1:4598 CONWAY LANDING DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8116
Practice Address - Country:US
Practice Address - Phone:786-817-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF03240516363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner