Provider Demographics
NPI:1386426492
Name:PEREZ, NYDIA KAYANNA
Entity type:Individual
Prefix:
First Name:NYDIA
Middle Name:KAYANNA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9975 UNIVERSITY PKWY APT N106
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5473
Mailing Address - Country:US
Mailing Address - Phone:904-487-4136
Mailing Address - Fax:
Practice Address - Street 1:5345 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1529
Practice Address - Country:US
Practice Address - Phone:850-626-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-300455106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician