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Organization
PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC
Active
Organization
PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC
Active
Other names
Peace River Center
Organization subpart
No
Provider details
NPI number
Authorized official
JO DECK BA, CPC (CREDENTIALING SPECIALIST)
(863) 519-0575
Entity
Organization
Contact information
Practice address
1831 GILMORE AVE, LAKELAND, FL 33805-3017
(863) 519-0575
(863) 582-9251
Mailing address
PO BOX 1559, BARTOW, FL 33831-1559
(863) 519-0575
(863) 582-9251
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060310422
—
FL
Enumeration date
02/24/2022
Last updated
05/04/2026
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