Healthcare Provider Details

I. General information

NPI: 1902348931
Provider Name (Legal Business Name): DEIBIS PEREZ R.N
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 56TH AVE NE
NAPLES FL
34120-7416
US

IV. Provider business mailing address

3440 56TH AVE NE
NAPLES FL
34120-7416
US

V. Phone/Fax

Practice location:
  • Phone: 239-207-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9378593
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number9378593
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number9378593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: