Healthcare Provider Details

I. General information

NPI: 1275249757
Provider Name (Legal Business Name): AMANDA ROSE PEREZ DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 BOSTON POST ROAD SUITE 101
MADISON CT
06443-3481
US

IV. Provider business mailing address

4700 EXCHANGE COURT SUITE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 860-669-6156
  • Fax: 860-664-0285
Mailing address:
  • Phone: 860-741-2225
  • Fax: 860-664-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number143705
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12617
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: