Provider Demographics
NPI:1902568124
Name:PEREZ, JAEMILYN (RN, BSN)
Entity Type:Individual
Prefix:MISS
First Name:JAEMILYN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0863
Mailing Address - Country:US
Mailing Address - Phone:787-394-7502
Mailing Address - Fax:
Practice Address - Street 1:446 AVE JUAN ROSADO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4265
Practice Address - Country:US
Practice Address - Phone:787-880-0384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR092043163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR092043Medicaid