Healthcare Provider Details

I. General information

NPI: 1255918553
Provider Name (Legal Business Name): JEFFERSON MARK PEREZ TONEL APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 MARKS STREET
HENDERSON NV
89014
US

IV. Provider business mailing address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2386
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-1000
  • Fax: 702-765-7998
Mailing address:
  • Phone: 702-383-2620
  • Fax: 702-383-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number839052
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: