Healthcare Provider Details

I. General information

NPI: 1609680065
Provider Name (Legal Business Name): EMILY ANN PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY EBERSOLD

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE
STUART FL
34994-2346
US

IV. Provider business mailing address

889 SE COURANCES DR
PORT SAINT LUCIE FL
34984-6686
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-5200
  • Fax:
Mailing address:
  • Phone: 561-284-2991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11036427
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11036427
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: