Healthcare Provider Details

I. General information

NPI: 1366334021
Provider Name (Legal Business Name): JULISSA MARIE PEREZ MSN, ARPN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 NW 10TH AVE STE 141
MIAMI FL
33136-1013
US

IV. Provider business mailing address

1580 NW 10TH AVE STE 141
MIAMI FL
33136-1013
US

V. Phone/Fax

Practice location:
  • Phone: 305-246-8441
  • Fax: 305-243-7409
Mailing address:
  • Phone: 305-246-8441
  • Fax: 305-243-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11041129
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11041129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: