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General NPI Number Information
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NPI Number | 1134766223
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Entity Type | Individual
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Provider Name | LUCEYDIS PERNUT
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Gender | Female
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Dates
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Enumeration Date | 12/08/2019
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 3176 S UNIVERSITY DR
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City | MIRAMAR
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State | FL
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Zip | 33025-3002
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Country | US
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Telephone | 954-544-2617
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Fax |
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Provider Business Mailing Address
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Address Line | 948 RAVEN AVE
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City | MIAMI SPRINGS
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State | FL
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Zip | 33166-3835
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Country | US
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Telephone | 786-333-4096
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11004888
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11004888
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License Number State | FL
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