Provider Demographics
NPI:1871070920
Name:NUAL PEREZ, JUSTO (RN)
Entity type:Individual
Prefix:
First Name:JUSTO
Middle Name:
Last Name:NUAL PEREZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LAKE JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:MASCOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:34753-8806
Mailing Address - Country:US
Mailing Address - Phone:321-333-6996
Mailing Address - Fax:
Practice Address - Street 1:16 LAKE JACKSON DR
Practice Address - Street 2:
Practice Address - City:MASCOTTE
Practice Address - State:FL
Practice Address - Zip Code:34753-8806
Practice Address - Country:US
Practice Address - Phone:321-333-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9490639163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse