MEDICARE: JUSTO NUAL PEREZ RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN9490639	FL

General Provider Information

NPI Number	:	1871070920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTO NUAL PEREZ RN

Provider Business Mailing Address
First Line	:	16 LAKE JACKSON DR
Second Line	:
City	:	MASCOTTE
State	:	FL
Zip	:	34753-8806
Country	:	US
Telephone Number	:	321-333-6996
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 LAKE JACKSON DR
Second Line	:
City	:	MASCOTTE
State	:	FL
Zip	:	34753-8806
Country	:	US
Telephone Number	:	321-333-6996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2018
Last Update Date	:	07/22/2018

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