Amanda B Peacock, ACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

9349014 Issued in FL

Practice address

3 Shircliff Way
Suite 714
Jacksonville, FL 32204-4757

Phone

(904) 308-2006

Fax

(904) 308-7111

NPI assigned

Aug 30, 2012

Last updated

Feb 11, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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.

• Physical Medicine Specialists, Inc.

  dba Brooks Rehabilitation Medical Group

  • Physical Medicine & Rehabilitation Physician
  • Jacksonville, FL
  • NPI 1952343261
  Medicare reassignment NPD
• St Vincents Ambulatory Care Inc

  • Neurological Surgery Physician
  • Jacksonville, FL
  • NPI 1417987124
  Medicare reassignment NPD
• St Vincents Ambulatory Care Inc

  dba Ascension St Vincent's Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Jacksonville, FL
  • NPI 1679226690
  NPD

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1669721155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3599 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164252",
            "telephone_number": "904-345-7776",
            "fax_number": "904-345-7772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SHIRCLIFF WAY",
            "address_2": "SUITE 714",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044757",
            "telephone_number": "904-308-2006",
            "fax_number": "904-308-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "AMANDA",
        "middle_name": "B",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-30",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "9349014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peaches-NA-Basket Adult Health Care Services (Peaches-Na-Basket Adult Services)
• Peachesnabasket Adult Health Services (PeachesNaBasketAdult Services)
• John Thomas Peachey, PSY.D.
• Peacock Companion & Caregiving Serivce
• Kerrie Peacock-Preston, PA-C
• Carly Peacock, LMT
• Karlee Peacock
• Lisa Lynn3 Peacock
• Mark Allen Peacock, M.D.
• Mary Ann Marie Peacock, ARNP

• Acute Care Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Acute Care Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; 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.