Healthcare Provider Details

I. General information

NPI: 1699691337
Provider Name (Legal Business Name): AMANDA PEREZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2784 ARDSLEY CIR NE UNIT 4
LELAND NC
28451-6097
US

IV. Provider business mailing address

2784 ARDSLEY CIR NE UNIT 4
LELAND NC
28451-6097
US

V. Phone/Fax

Practice location:
  • Phone: 203-873-9593
  • Fax:
Mailing address:
  • Phone: 203-873-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberPERE-MIRI1
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number374126
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: