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NPI Code Detail

MEDICARE: MR. ANDRES PERALTA FNP-C

MEDICARE: MR. ANDRES PERALTA FNP-C
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
1363L00000XNurse Practitioner0024190754VA

General Provider Information

NPI Number : 1598595241
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDRES PERALTA FNP-C
Provider Business Mailing Address
First Line : 4050 BATTERY BLVD APT 403
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23185-4770
Country : US
Telephone Number : 757-784-7040
Fax Number :
Provider Business Practice Location Address
First Line : 120 KINGS WAY STE 3200
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23185-2511
Country : US
Telephone Number : 757-253-0051
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2024
Last Update Date : 08/07/2024

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