MEDICARE: RICARDO JOSE PEREA ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	5006159	NC

General Provider Information

NPI Number	:	1083058770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO JOSE PEREA ANP

Provider Business Mailing Address
First Line	:	PO BOX 1332
Second Line	:
City	:	FRANKLIN
State	:	NC
Zip	:	28744-1332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 WESTCARE DR
Second Line	:	SUITE 302
City	:	SYLVA
State	:	NC
Zip	:	28779-5290
Country	:	US
Telephone Number	:	828-586-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	04/24/2013

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