Provider Demographics
NPI:1982058269
Name:PERALES, PAIGE (ARNP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:PERALES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:FUTCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-1137
Mailing Address - Country:US
Mailing Address - Phone:321-952-9696
Mailing Address - Fax:321-952-7937
Practice Address - Street 1:7227 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-5020
Practice Address - Country:US
Practice Address - Phone:321-877-2740
Practice Address - Fax:321-877-2793
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9344584363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics