Individual
DERESH TAMARA PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
701 GROVE RD FL 5, GREENVILLE, SC 29605-4210
(864) 455-4411
(864) 455-4480
Mailing address
PO BOX 740013, ATLANTA, GA 30374-0013
(312) 733-9730
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21493
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP4995
—
SC
Enumeration date
01/09/2018
Last updated
04/17/2025
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