Individual
MR. MICHAEL NATHAN PEDDYCOART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
7406 FULLERTON ST, JACKSONVILLE, FL 32256-3552
(863) 529-6259
Mailing address
7406 FULLERTON ST, JACKSONVILLE, FL 32256-3552
(863) 529-6259
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN9227732
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN9227732
FL APRN LICENSE
FL
01
—
RN9227732
FL RN LICENSE
FL
Enumeration date
08/28/2015
Last updated
07/02/2020
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