Individual
TARA N PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1021 BANDANA BLVD E, SUITE 100, SAINT PAUL, MN 55108-5113
(651) 241-9700
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
(612) 262-4258
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R1753372
MN
Other
Enumeration date
08/14/2013
Last updated
03/03/2014
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