Provider Demographics
NPI:1053304121
Name:PEREZ-BURGOS, IDANIA LUCIA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:IDANIA
Middle Name:LUCIA
Last Name:PEREZ-BURGOS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:IDANIA
Other - Middle Name:LUCIA
Other - Last Name:PEREZ ARNP INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:3131 SW 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2223
Mailing Address - Country:US
Mailing Address - Phone:786-663-6498
Mailing Address - Fax:
Practice Address - Street 1:7306 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3804
Practice Address - Country:US
Practice Address - Phone:305-220-0220
Practice Address - Fax:305-463-6659
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2688452363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304082800Medicaid
FLE6546BMedicare ID - Type Unspecified
P44926Medicare UPIN