Individual
MRS. PAULA PEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
520 A1A N STE 101, ATTN: CREDENTIALING DEPARTMENT, PONTE VEDRA BEACH, FL 32082-2260
(904) 273-6900
(904) 273-9022
Mailing address
PO BOX 45443, SALT LAKE CITY, UT 84145-0443
(904) 202-1032
(904) 376-4107
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
ARNP 9262800
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN PROCESS
RAILROAD MEDICARE
FL
Enumeration date
06/16/2015
Last updated
12/20/2018
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