Provider Demographics
NPI:1861091217
Name:DIANA PEREZ-NUNEZ, APRN, CO
Entity type:Organization
Organization Name:DIANA PEREZ-NUNEZ, APRN, CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-C
Authorized Official - Phone:561-843-0330
Mailing Address - Street 1:23109 OLD INLET BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6825
Mailing Address - Country:US
Mailing Address - Phone:561-843-0330
Mailing Address - Fax:
Practice Address - Street 1:7320 E FLETCHER AVE STE 108
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-0916
Practice Address - Country:US
Practice Address - Phone:561-264-6370
Practice Address - Fax:561-461-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102504200Medicaid