Paula Peacock, ARNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

ARNP 9262800 Issued in FL

Practice address

520 A1A N Ste 101
Attn: Credentialing Department
Ponte Vedra Beach, FL 32082-2260

Phone

(904) 273-6900

Fax

(904) 273-9022

NPI assigned

Jun 16, 2015

Last updated

Dec 20, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Orlando Physicians Network Inc

  • Internal Medicine Physician
  • Orlando, FL
  • NPI 1568693554
  Medicare reassignment NPD
• Baptist Primary Care Inc

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1508817529
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545264000000",
    "number": "1194106005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45443",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841450443",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 A1A N STE 101",
            "address_2": "ATTN: CREDENTIALING DEPARTMENT",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822260",
            "telephone_number": "904-273-6900",
            "fax_number": "904-273-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "PAULA",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-16",
        "last_updated": "2018-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "ARNP 9262800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "IN PROCESS",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Manish R Patel, MP
• Shreena B. Patel, D.M.D.
• Paths 2 Peace LLC
• James Randall Patrinely Jr., MD
• Peace of Heart Community
• Pediatric Associates of Jacksonville, PA
• Penney Weeks DMD PA
• Pep Network LLC
• Joshua Edward Perry, D.M.D.
• Anthony Andrew Perszyk, M.D.

• Primary Care Nurse Practitioner in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Primary Care Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.