CORY GRANT PETERS


Address: 10475 Centurion Pkwy N, Suite 220, Jacksonville, FL 32256
Phone: 9046340640

CORY GRANT PETERS (NPI# 1144395708) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1144395708
Entity Type Individual
Full Name CORY GRANT PETERS
Credential PA
Practice Address 10475 Centurion Pkwy N
Suite 220
Jacksonville
FL 32256
Mailing Address 6500 Bowden Rd
Suite 103
Jacksonville
FL 32216-8070
Practice Telephone 9046340640
Practice Fax Number 9046340203
Mailing Telephone 9046340640
Mailing Fax Number 9046340203
Enumeration Date 2006-11-21
Last Update Date 2018-05-15
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 2255A2300X Specialist/Technologist
Specialization: Athletic Trainer
466 SC Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
PA9106781 FL Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
FL LICENSE PA9106781 01

Office Location

Street Address 10475 CENTURION PKWY N
SUITE 220
City JACKSONVILLE
State FL
Zip Code 32256

Providers in the same location

NPI Name Taxonomy Address Enumeration
1265438493 James Douglas Green Jr. Specialist 10475 Centurion Pkwy N, Ste 303, Jacksonville, FL 32256-5003 2005-06-22
1285170282 Kelli D. Williams Physician Assistant 10475 Centurion Pkwy N, Suite 104, Jacksonville, FL 32256-5003 2017-01-13
1235593641 Ryan M Funderburk Audiologist 10475 Centurion Pkwy N, Suite 303, Jacksonville, FL 32256-5003 2016-04-12
1275998908 Se Orthopedic Specialists Non-Pharmacy Dispensing Site 10475 Centurion Pkwy N, Suite 220, Jacksonville, FL 32256-5003 2015-12-23
1821479650 Kristen Edenfield Audiologist 10475 Centurion Pkwy N, #303, Jacksonville, FL 32256-5003 2015-06-17
1952789547 Christopher Perez De Corcho Physical Therapist 10475 Centurion Pkwy N, #304, Jacksonville, FL 32256-5003 2015-05-14
1588059083 Krista L Boniecki Physical Therapist 10475 Centurion Pkwy N, Suie 220, Jacksonville, FL 32256-5003 2015-04-01
1679970990 Paul D Sturney Physician Assistant 10475 Centurion Pkwy N, Suite 220, Jacksonville, FL 32256-5003 2014-12-02
1326440801 Healthcore Wellness, P.a. Chiropractor 10475 Centurion Pkwy N, Suite 201, Jacksonville, FL 32256-5003 2014-09-16
1902213770 Tonya Goodson Nurse Practitioner 10475 Centurion Pkwy N, #203, Jacksonville, FL 32256-5003 2014-07-14
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1841890464 Alice Sanchez Dietitian, Registered 7643 Gate Parkway, Suite 104-1128, Jacksonville, FL 32256 2020-11-01
1093327702 Oaktree Dental LLC Clinic/Center 14595 Philips Highway, Jacksonville, FL 32256 2020-08-24
1538787866 Tywanna Council Massage Therapist 4720 Salisbury Road #102, Jacksonville, FL 32256 2020-07-13
1275155368 Christy Orellana Social Worker 5011 Gate Parkway Bldg 100 Suite 100, Jacksonville, FL 32256 2020-05-11
1376175117 Diane Stover Case Manager/Care Coordinator 7001 A. C. Skinner Parkway, Jacksonville, FL 32256 2020-02-10
1982235859 Sandra Josefina Baez Nunez Nurse Practitioner 10739 Deerwood Park Blvd, Suite 200, Jacksonville, FL 32256 2020-01-30
1205476496 Point Meadows Dental Center, Inc. Dentist 10915 Baymeadows Rd, #106, Jacksonville, FL 32256 2020-01-15
1598324113 Dhaval Yogeshkumar Shah Dentist 8206 Philips Hwy., Suite 21, Jacksonville, FL 32256 2019-06-07
1003472499 Dade Medical, Inc. Durable Medical Equipment & Medical Supplies 9143 Philips Highway Suite 270, Jacksonville, FL 32256 2019-05-13
1003479726 Nichole Bashara Behavior Technician 8383 Baymeadows Rd, Jacksonville, FL 32256 2019-04-18
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1255858650 John Matthew Dumas Physician Assistant 3640 Newcomb Rd, Jacksonville, FL 32218-1510 2017-08-25
1932432093 Andrew Gibson Physician Assistant 12869 Dunes Ct, Jacksonville, FL 32225-3889 2009-09-08
1871556340 Kevin Michael Cofran Physician Assistant 1838 Mcintosh Pl, Jacksonville, FL 32210-2224 2006-04-07
1811950272 Jaclyn Michelle Tyo Physician Assistant 2627 Riverside Ave Ste 300, Jacksonville, FL 32204-4712 2006-04-07
1912969015 Wendy Elizabeth Ashby Physician Assistant 3639 Darnall Pl, Jacksonville, FL 32217-4215 2006-04-04
1407839616 Jennifer Renee Wren Physician Assistant 1820 Barrs St, Suite 701, Jacksonville, FL 32204-4742 2005-11-22
1962403949 Katherine Elizabeth Stenberg Curry Physician Assistant 841 Prudential Dr, Ufjax - Pediatric Cardiothoracic Surgery, Jacksonville, FL 32207-8329 2005-08-02
1346848173 Marisa Elaine Long Physician Assistant 836 Prudential Dr Ste 1001, Jacksonville, FL 32207-8337 2020-10-14
1235775438 Jacqueline M Evans Physician Assistant 2 Shircliff Way Ste 605, Jacksonville, FL 32204-4762 2019-11-22
1992363733 Lindsey Allison Baroch Physician Assistant 3627 University Blvd S Ste 550, Jacksonville, FL 32216-7401 2019-06-05
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Competitor

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City JACKSONVILLE
Zip Code 32256

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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