Provider Demographics
NPI:1376180430
Name:PEREZ, MARIE DANIELLA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:DANIELLA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 LEE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4117
Practice Address - Country:US
Practice Address - Phone:786-385-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN288851163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0200XNursing Service ProvidersRegistered NurseOncologyGroup - Single Specialty