Provider Demographics
NPI:1134764731
Name:PEREZ, CARLOS LEONARDO (RN)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:LEONARDO
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 1:1175 E KENNEDY BLVD
Mailing Address - Street 2:N 639
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602
Mailing Address - Country:US
Mailing Address - Phone:813-966-1023
Mailing Address - Fax:
Practice Address - Street 1:1175 E KENNEDY BLVD
Practice Address - Street 2:N 639
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602
Practice Address - Country:US
Practice Address - Phone:813-966-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9443076163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse