Provider Demographics
NPI:1811311251
Name:PEREZ-HORRELL, MARILYN MICHELE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:MICHELE
Last Name:PEREZ-HORRELL
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 1:4266 SUNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2425
Mailing Address - Country:US
Mailing Address - Phone:904-268-5200
Mailing Address - Fax:
Practice Address - Street 1:4266 SUNBEAM RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2425
Practice Address - Country:US
Practice Address - Phone:904-268-5200
Practice Address - Fax:904-268-5200
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2523212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010646200Medicaid
GA003143971BMedicaid
FL010646200Medicaid
FLP01411817Medicare PIN