Healthcare Provider Details

I. General information

NPI: 1124583695
Provider Name (Legal Business Name): MELIZA MERCEDES PEREA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 N KENDALL DR STE 100
MIAMI FL
33176-8814
US

IV. Provider business mailing address

18021 SW 89TH CT
PALMETTO BAY FL
33157-5915
US

V. Phone/Fax

Practice location:
  • Phone: 305-994-1825
  • Fax:
Mailing address:
  • Phone: 786-624-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11000481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: