Provider Demographics
NPI:1518612233
Name:PEREZ, ELI SCOTT (BSN, APN)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:SCOTT
Last Name:PEREZ
Suffix:
Gender:M
Credentials:BSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 BROOKHILL RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-9413
Mailing Address - Country:US
Mailing Address - Phone:309-219-3370
Mailing Address - Fax:
Practice Address - Street 1:5600 N GLEN ELM DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4340
Practice Address - Country:US
Practice Address - Phone:309-693-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily