Provider Demographics
NPI:1619487659
Name:PEREZ, JOEL ERNESTO (ARNP)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ERNESTO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:ERNESTO
Other - Last Name:PEREZ GRACIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12171 SW 268TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8001
Mailing Address - Country:US
Mailing Address - Phone:305-278-0200
Mailing Address - Fax:786-430-1583
Practice Address - Street 1:8726 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1714
Practice Address - Country:US
Practice Address - Phone:813-712-1726
Practice Address - Fax:813-925-4640
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9397644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily