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

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

Other identifiers 2

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 and National Provider Directory roles.

• Physical Medicine Specialists, Inc.

  • 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

  • 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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01118046",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-FL",
            "identifier": "Y0E3S",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peaches-NA-Basket Adult Health Care Services
• Peachesnabasket Adult Health 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.