Provider Demographics
NPI:1417528415
Name:PEREZ RODRIGUEZ, LILLIAM (APRN)
Entity Type:Individual
Prefix:
First Name:LILLIAM
Middle Name:
Last Name:PEREZ RODRIGUEZ
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 1:110 NE 2ND PL STE 106
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2553
Mailing Address - Country:US
Mailing Address - Phone:239-244-2917
Mailing Address - Fax:239-236-1991
Practice Address - Street 1:110 NE 2ND PL STE 106
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2553
Practice Address - Country:US
Practice Address - Phone:239-244-2917
Practice Address - Fax:239-236-1991
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily