Provider Demographics
NPI:1053739169
Name:PEREZ, JOSE (RN)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11814 N 56TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1698
Mailing Address - Country:US
Mailing Address - Phone:813-642-9000
Mailing Address - Fax:813-642-9001
Practice Address - Street 1:11814 N 56TH ST STE A
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1698
Practice Address - Country:US
Practice Address - Phone:813-642-9000
Practice Address - Fax:813-642-9001
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993849163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-9785OtherPTAN