Provider Demographics
NPI:1619623873
Name:PEREZ, PHILLIP ANTHONY (RN)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:PEREZ
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 1:23440 SW 107TH PL
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6285
Mailing Address - Country:US
Mailing Address - Phone:305-721-8831
Mailing Address - Fax:
Practice Address - Street 1:23440 SW 107TH PL
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:FL
Practice Address - Zip Code:33032-6285
Practice Address - Country:US
Practice Address - Phone:305-721-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032812367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty