Healthcare Provider Details

I. General information

NPI: 1386589737
Provider Name (Legal Business Name): STEPHANIE PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 LAKE NONA BLVD
ORLANDO FL
32827-7408
US

IV. Provider business mailing address

9486 MAPLE HILL CT
ORLANDO FL
32832-5644
US

V. Phone/Fax

Practice location:
  • Phone: 407-266-1536
  • Fax:
Mailing address:
  • Phone: 407-446-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: