Healthcare Provider Details

I. General information

NPI: 1922762467
Provider Name (Legal Business Name): JERIKA TERESE PERRY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 OAKFIELD DR STE 205
BRANDON FL
33511-0827
US

IV. Provider business mailing address

3606 NATURAL TRACE ST
PLANT CITY FL
33565-5986
US

V. Phone/Fax

Practice location:
  • Phone: 239-690-6906
  • Fax: 813-291-7396
Mailing address:
  • Phone: 813-492-1717
  • Fax: 813-409-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11015468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: