Active NPI
Elaine Peacock
- Family Nurse Practitioner
- Niceville, FL
National Provider Identifier
1053709451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- ARNP9455285
- Practice address
- 4562 E Highway 20
Niceville, FL 32578-8831 - Phone
- (850) 897-8550
- NPI assigned
- Jan 7, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 02282 | NM | |
| Family Nurse Practitioner | 363LF0000X | ARNP9455285 | FL | Primary |
Addresses
Primary practice location
4562 E Highway 20
Niceville, FL 32578-8831
Mailing address
4562 E Highway 20
Niceville, FL 32578-8831
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NPI & TIN | Other | NM | BCBS OF NM |
| 21528365 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ARNP9455285 | FL | MD | Family Nurse Practitioner |
| 02282 | NM | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491782400000",
"number": "1053709451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4562 E HIGHWAY 20",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325788831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4562 E HIGHWAY 20",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325788831",
"telephone_number": "850-897-8550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACOCK",
"first_name": "ELAINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-07",
"last_updated": "2017-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NM",
"license": "02282",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "ARNP9455285",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NM",
"identifier": "NPI & TIN",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "21528365",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Niceville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.