Provider Demographics
NPI:1538744677
Name:MP ADVANCED PRACTICE PA
Entity type:Organization
Organization Name:MP ADVANCED PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAIL
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-374-7521
Mailing Address - Street 1:15679 SW 10TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2420
Mailing Address - Country:US
Mailing Address - Phone:786-374-7521
Mailing Address - Fax:
Practice Address - Street 1:10300 SUNSET DR STE 354
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3020
Practice Address - Country:US
Practice Address - Phone:305-714-2923
Practice Address - Fax:305-851-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11000079OtherLICENSE