Provider Demographics
NPI:1447655766
Name:PERARD, REGINALD (APRN)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:
Last Name:PERARD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 COCONUT CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3913
Mailing Address - Country:US
Mailing Address - Phone:954-281-7700
Mailing Address - Fax:954-715-7603
Practice Address - Street 1:5100 COCONUT CREEK PKWY
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-3913
Practice Address - Country:US
Practice Address - Phone:954-281-7700
Practice Address - Fax:954-715-7603
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9325998363LP0200X
FLARNP9325998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020894800Medicaid