Provider Demographics
NPI:1801494224
Name:VELAZQUEZ PEREZ, LOURDES ELOISA (APRN)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:ELOISA
Last Name:VELAZQUEZ PEREZ
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9545 SW 24TH ST APT B311
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8054
Mailing Address - Country:US
Mailing Address - Phone:786-718-2769
Mailing Address - Fax:
Practice Address - Street 1:9545 SW 24TH ST APT B311
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-8054
Practice Address - Country:US
Practice Address - Phone:786-718-2769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009739363L00000X
FL2022067826363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner