Provider Demographics
NPI:1598595241
Name:PERALTA, ANDRES (FNP-C)
Entity type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:
Last Name:PERALTA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANDRES
Other - Middle Name:
Other - Last Name:PERALTA MAZZITELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4050 BATTERY BLVD APT 403
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-4770
Mailing Address - Country:US
Mailing Address - Phone:757-784-7040
Mailing Address - Fax:
Practice Address - Street 1:120 KINGS WAY STE 3200
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2511
Practice Address - Country:US
Practice Address - Phone:757-253-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner