Provider Demographics
NPI:1386661973
Name:PEREZ, EMILIANA (MSN ARNP)
Entity type:Individual
Prefix:MS
First Name:EMILIANA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSN ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8828 BLISS ROAD
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534
Mailing Address - Country:US
Mailing Address - Phone:813-677-2757
Mailing Address - Fax:
Practice Address - Street 1:10508 GIBSONTON DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5434
Practice Address - Country:US
Practice Address - Phone:954-983-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3127132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301816400Medicaid
FL301816400Medicaid
E67872Medicare ID - Type Unspecified