Provider Demographics
NPI:1710512587
Name:PERRY, EMMA SHARON (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:SHARON
Last Name:PERRY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:SHARON
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 W AVENIDA GAVIOTA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5442
Mailing Address - Country:US
Mailing Address - Phone:949-547-5968
Mailing Address - Fax:
Practice Address - Street 1:212 W AVENIDA GAVIOTA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5442
Practice Address - Country:US
Practice Address - Phone:949-547-5968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF01200740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily