Individual provider Active NPI

Dianka Perez

  • Gerontology Nurse Practitioner
  • Fort Lauderdale, FL
National Provider Identifier
1154974830
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
11003364 Issued in FL
Practice address
104 SW 24TH Ave
Fort Lauderdale, FL 33312-1450
Phone
(954) 366-8151
NPI assigned
Jul 22, 2019
Last updated
Jan 30, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 11003364 FL Primary

Addresses

Primary practice location

104 SW 24TH Ave
Fort Lauderdale, FL 33312-1450

Mailing address

20200 W Dixie Hwy Ste 1108
Aventura, FL 33180-1922
Phone (786) 275-3725

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191219000064 FL Practitioner - Nurse Practitioner 8123452406 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11003364FLMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Healthcare Centers, LP CurrentSince Feb 21, 2025 Accepting new patients

Locations

1874 W Hillsboro Blvd
Ste F
Deerfield Beach, FL 33442
Phone (954) 426-4544

3075 E Commercial Blvd
Ste 1A
Ft Lauderdale, FL 33308
Phone (954) 491-6200

4330 Sheridan St
Ste 201B
Hollywood, FL 33021
Phone (954) 519-2201

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/4307/brand/2/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1154974830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20200 W DIXIE HWY STE 1108",
            "city": "AVENTURA",
            "state": "FL",
            "postal_code": "331801922",
            "telephone_number": "786-275-3725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 SW 24TH AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333121450",
            "telephone_number": "954-366-8151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "DIANKA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-22",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "11003364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.