Provider Demographics
NPI:1285447284
Name:PEREZ, TINA LEA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LEA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LEA
Other - Last Name:PEREZ-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11812 GOLDEN BLVD APT 904
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-3114
Mailing Address - Country:US
Mailing Address - Phone:712-899-3042
Mailing Address - Fax:
Practice Address - Street 1:11812 GOLDEN BLVD APT 904
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-3114
Practice Address - Country:US
Practice Address - Phone:712-899-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE85057163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice