| Doctor Name: | MRS. PAULA PEACOCK |
| NPI Number: | 1194106005 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | ARNP 9262800 |
| Business Practice Address: | 520 A1a N Ste 101 Attn: Credentialing Department Ponte Vedra Beach, FL - 320822260 |
| Business Phone Number: | 9042736900 |
| Business Fax Number: | 9042739022 |
| Mailing Address: | Po Box 40767, Attn: Credentialing Department JACKSONVILLE |
| State: | FL |
| Postal Code: | 322030767 |
| Phone Number: | 9043763707 |
| Fax Number: | 9043915001 |
| NPI Enumeration Date: | 06/16/2015 |
| NPI Last Update Date: | 08/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | ARNP 9262800 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |