Provider Demographics
NPI:1417721242
Name:PEREZ FERNANDEZ, DORALIS (APRN)
Entity Type:Individual
Prefix:MS
First Name:DORALIS
Middle Name:
Last Name:PEREZ FERNANDEZ
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 1:3159 SW 153RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4875
Mailing Address - Country:US
Mailing Address - Phone:786-757-3497
Mailing Address - Fax:
Practice Address - Street 1:3159 SW 153RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4875
Practice Address - Country:US
Practice Address - Phone:786-757-3497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily