Provider Demographics
NPI:1417656182
Name:PEREZ FREITES, EDGAR EDUARDO (RN)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:EDUARDO
Last Name:PEREZ FREITES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11055 HANLON TERRACE ALY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-1775
Mailing Address - Country:US
Mailing Address - Phone:407-360-3253
Mailing Address - Fax:
Practice Address - Street 1:11055 HANLON TERRACE ALY
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-1775
Practice Address - Country:US
Practice Address - Phone:407-360-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9623530163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse