Provider Demographics
NPI:1023713971
Name:PEREZ, VICENTE (APRN)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 AMHERST ST E
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-0525
Mailing Address - Country:US
Mailing Address - Phone:305-926-1495
Mailing Address - Fax:
Practice Address - Street 1:6811 PORTO FINO CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4354
Practice Address - Country:US
Practice Address - Phone:239-208-6648
Practice Address - Fax:239-931-0221
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily