Individual
JUNIOR MANUEL PERALTA PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
9050 PINES BLVD STE 150, PEMBROKE PINES, FL 33024-6400
(954) 872-0555
Mailing address
5705 W 12TH LN, HIALEAH, FL 33012-2266
(786) 778-0968
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
APRN11014221
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11014221
FL
Other
Enumeration date
08/07/2021
Last updated
07/26/2024
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