Provider Demographics
NPI:1821741836
Name:PEREZ, JESSICA FAITH (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FAITH
Last Name:PEREZ
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 1:2534 STAGNARO RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-3643
Mailing Address - Country:US
Mailing Address - Phone:941-600-8120
Mailing Address - Fax:
Practice Address - Street 1:5810 CANDYTUFT PL
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-2646
Practice Address - Country:US
Practice Address - Phone:813-435-3897
Practice Address - Fax:866-404-2708
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9489346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily