Healthcare Provider Details

I. General information

NPI: 1053739169
Provider Name (Legal Business Name): JOSE PEREZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11814 N 56TH ST STE A
TEMPLE TERRACE FL
33617-1698
US

IV. Provider business mailing address

11814 N 56TH ST STE A
TEMPLE TERRACE FL
33617-1698
US

V. Phone/Fax

Practice location:
  • Phone: 813-642-9000
  • Fax: 813-642-9001
Mailing address:
  • Phone: 813-642-9000
  • Fax: 813-642-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number299993849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: