Healthcare Provider Details

I. General information

NPI: 1245097773
Provider Name (Legal Business Name): JORGE PEREZ NAZCO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 VISCAYA PKWY STE 2
CAPE CORAL FL
33990-6200
US

IV. Provider business mailing address

911 NICHOLAS PKWY W
CAPE CORAL FL
33991-2562
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-0111
  • Fax:
Mailing address:
  • Phone: 239-240-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11030624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: