=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376079467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARICEL PEREZ TORRES APRN CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2017
-----------------------------------------------------
Last Update Date | 10/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3501 JOHNSON ST FL 2
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-265-3441
-----------------------------------------------------
Fax | 954-368-0195
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 CORPORATE WAY DOOR D
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33025-3925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-276-5685
-----------------------------------------------------
Fax | 954-985-7074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | 9308321
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------