Individual provider Active NPI

Destanie Perez

  • Emergency Clinical Nurse Specialist
  • Hollis, NY
National Provider Identifier
1700734563
Registry record updated Mar 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Clinical Nurse SpecialistTaxonomy code 364SE0003X
License
925107 Issued in NY
Practice address
18419 90TH Ave
Hollis, NY 11423-1706
Phone
(203) 887-1422
NPI assigned
Mar 18, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Clinical Nurse Specialist 364SE0003X 925107 NY Primary

Addresses

Primary practice location

18419 90TH Ave
Hollis, NY 11423-1706

Mailing address

18419 90TH Ave
Hollis, NY 11423-1706

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
925107NYMDEmergency Clinical Nurse Specialist

NPI Registry JSON

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

{
    "created_epoch": "1773792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773792000000",
    "number": "1700734563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18419 90TH AVE",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "114231706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18419 90TH AVE",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "114231706",
            "telephone_number": "203-887-1422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "DESTANIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-03-18",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SE0003X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Emergency",
            "state": "NY",
            "license": "925107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollis, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.