Individual provider · NPI-1

Mark Perez Agustin, ACNP

Nurse Practitioner · Evanston, IL

NPI number1730855677

StatusActive

Last updated in NPPESSep 17, 2021

Details

NPI: 1730855677
Entity type: Individual (NPI-1)
Name: Mark Perez Agustin
Credential: ACNP
Sex: Male
Sole proprietor: Yes
Enumeration date: Aug 20, 2021
Certification date: Sep 1, 2021
Last updated: Sep 17, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363L00000X	Nurse Practitioner	209019626	IL	Yes
363LA2100X	Nurse Practitioner, Acute Care	209019626	IL

Practice location

2650 Ridge Ave.
Dept. Of Anesthesia
Evanston, IL 60201-1057

Phone 847-570-2760 · Fax 847-570-2921

Mailing address

2650 Ridge Ave.
Dept. Of Anesthesia
Evanston, IL 60201-1057

Phone 847-570-2760 · Fax 847-570-2921

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