Provider Demographics
NPI:1255109245
Name:PEREZ, MYRA MELINDA (RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:MELINDA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3545
Mailing Address - Country:US
Mailing Address - Phone:956-867-1426
Mailing Address - Fax:
Practice Address - Street 1:2010 E 21ST ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3545
Practice Address - Country:US
Practice Address - Phone:956-867-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2023168772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily