Provider Demographics
NPI:1124771803
Name:PEREZ ANTELA, MADELIN (APRN)
Entity type:Individual
Prefix:
First Name:MADELIN
Middle Name:
Last Name:PEREZ ANTELA
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 1:1108 CARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-4806
Mailing Address - Country:US
Mailing Address - Phone:469-901-2238
Mailing Address - Fax:
Practice Address - Street 1:2000 ESTERS RD STE 120
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-8020
Practice Address - Country:US
Practice Address - Phone:369-586-4574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty