Provider Demographics
NPI:1366223695
Name:PERDOMO GONZALEZ, MYRIAM VIVIANA (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MYRIAM
Middle Name:VIVIANA
Last Name:PERDOMO GONZALEZ
Suffix:
Gender:F
Credentials:APRN, FNP-BC
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Mailing Address - Street 1:5102 NW 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:954-838-5414
Practice Address - Street 1:1970 S UNIVERSITY DR STE 24
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5846
Practice Address - Country:US
Practice Address - Phone:954-800-5686
Practice Address - Fax:954-838-5414
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily