Provider Demographics
NPI:1740625821
Name:PEREZ ISASI, LARISA (APRN)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:PEREZ ISASI
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 1:3180 SW 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2338
Mailing Address - Country:US
Mailing Address - Phone:786-970-4029
Mailing Address - Fax:
Practice Address - Street 1:7921 BIRD RD STE 39
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6747
Practice Address - Country:US
Practice Address - Phone:786-310-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9358714363LF0000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No104100000XBehavioral Health & Social Service ProvidersSocial Worker