Provider Demographics
NPI:1972872679
Name:PEREZ, EVELYN S (ARNP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:S
Last Name:PEREZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:S
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13685 DOCTOR'S WAY
Practice Address - Street 2:SUITE 310
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4300
Practice Address - Country:US
Practice Address - Phone:239-343-1400
Practice Address - Fax:239-343-1430
Is Sole Proprietor?:No
Enumeration Date:2011-12-26
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704204510363L00000X
FLARNP9427530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner