Provider Demographics
NPI:1912532698
Name:PERALTA PEREZ, MARIANA (APRN)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:PERALTA PEREZ
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 1:5609 MARIGOLD WAY APT 308
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2751
Mailing Address - Country:US
Mailing Address - Phone:239-234-7392
Mailing Address - Fax:
Practice Address - Street 1:5609 MARIGOLD WAY APT 308
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2751
Practice Address - Country:US
Practice Address - Phone:239-234-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily