Individual provider Active NPI

Laura A. Perez, PA-C

  • Physician Assistant
  • Cape Coral, FL
National Provider Identifier
1700138625
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9106765 Issued in FL
Practice address
413 Del Prado Blvd S Ste 101
Cape Coral, FL 33990-5703
Phone
(239) 443-1500
Fax
(239) 443-1510
NPI assigned
Oct 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9106765 FL Primary

Addresses

Primary practice location

413 Del Prado Blvd S Ste 101
Cape Coral, FL 33990-5703

Mailing address

15051 S Tamiami TRL Ste 203
Fort Myers, FL 33908-5182
Phone (239) 437-8810

Other identifiers 5

IdentifierTypeStateIssuer
Y04EHOtherFLBCBS FL
P1004406OtherFLFREEDOM HEALTH
9275941OtherFLAETNA
P01118217OtherFLRAILROAD MCR
P944517OtherFLOPTIMUM

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
I20121211000513 FL Practitioner - Physician Assistant 9133371545 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aqua Dermatology of Florida, PAGroup PAC ID 1153390414, 184 clinicians

Practice addresses (Care Compare)

1015 Crosspointe Dr
Naples, FL 34110-0949
Phone (239) 596-9075

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Naples Center for Dermatology & Riverchase Dermatology CurrentSince Apr 16, 2018 Accepting new patients

Locations

413 Del Prado Blvd S
Ste 101
Cape Coral, FL 33990
Phone (239) 443-1500

2366 Surfside Blvd
Ste C111
Cape Coral, FL 33991
Phone (239) 360-2795

7331 Gladiolus Dr
Fort Myers, FL 33908
Phone (239) 437-8810

15051 S Tamiami Trl
Ste 203
Fort Myers, FL 33908
Phone (239) 732-5959

1015 Crosspointe Dr
Naples, FL 34110
Phone (239) 596-9075

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: lwalgate@aquadermatology.emadirect.md

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1349222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1700138625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15051 S TAMIAMI TRL STE 203",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339085182",
            "telephone_number": "239-437-8810",
            "fax_number": "239-313-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 DEL PRADO BLVD S STE 101",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339905703",
            "telephone_number": "239-443-1500",
            "fax_number": "239-443-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "LAURA",
        "middle_name": "A.",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-03",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "Y04EH",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FREEDOM HEALTH",
            "identifier": "P1004406",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9275941",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCR",
            "identifier": "P01118217",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMUM",
            "identifier": "P944517",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Coral, FL

Sources for this page

Verify at the official NPI Registry.