Healthcare Provider Details

I. General information

NPI: 1649199514
Provider Name (Legal Business Name): MIGUEL ANGEL PEREZ AVILA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 SOUTHERN BLVD
WEST PALM BEACH FL
33406-3242
US

IV. Provider business mailing address

5924 NW BATCHELOR TER
PORT SAINT LUCIE FL
34986-3654
US

V. Phone/Fax

Practice location:
  • Phone: 561-800-4111
  • Fax: 716-631-9525
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: