Provider Demographics
NPI:1841909983
Name:PERNAS, ENRIQUE A (FPNP)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:A
Last Name:PERNAS
Suffix:
Gender:M
Credentials:FPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20133 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3428
Mailing Address - Country:US
Mailing Address - Phone:305-968-0018
Mailing Address - Fax:
Practice Address - Street 1:3500 POWERLINE RD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-5917
Practice Address - Country:US
Practice Address - Phone:888-867-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF10220441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner