Healthcare Provider Details

I. General information

NPI: 1609704568
Provider Name (Legal Business Name): KRYSTEL JOHANA PEREZ PRADA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6718 2ND ST
JUPITER FL
33458-3887
US

IV. Provider business mailing address

6718 2ND ST
JUPITER FL
33458-3887
US

V. Phone/Fax

Practice location:
  • Phone: 832-566-3768
  • Fax:
Mailing address:
  • Phone: 832-566-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberRN9609653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: