Provider Demographics
NPI:1497287213
Name:PERERA, JOSE (ARNP-FNP-C)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PERERA
Suffix:
Gender:M
Credentials:ARNP-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 SW 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5805
Mailing Address - Country:US
Mailing Address - Phone:786-333-5933
Mailing Address - Fax:
Practice Address - Street 1:1150 NW 72ND AVE STE 350
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1947
Practice Address - Country:US
Practice Address - Phone:305-591-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP-9255335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily