AMANDA B PEACOCK (NPI# 1669721155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669721155 |
| Entity Type | Individual |
| Full Name | AMANDA B PEACOCK |
| Credential | ACNP |
| Practice Address |
3 Shircliff Way Suite 714 Jacksonville FL 32204-4757 |
| Mailing Address |
Po Box 848457 Boston MA 02284-8457 |
| Practice Telephone | 9043082006 |
| Practice Fax Number | 9043087111 |
| Mailing Telephone | 9042965690 |
| Mailing Fax Number | 9042969542 |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2013-01-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
9349014 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS-FL | Y0E3S | 01 |
| FL | RAILROAD MEDICARE | P01118046 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740732924 | Amanda Peacock | Physician Assistant | 1200 Evergreen Cir, Eastman, GA 31023-3568 | 2016-11-03 |
| 1831300334 | Amanda B. Peacock | Social Worker | 21 Pequossette St, Watertown, MA 02472-2761 | 2007-05-25 |
| 1437627098 | Amanda E Peacock | Case Manager/Care Coordinator | 1544 Elmira St, Aurora, CO 80010-2116 | 2018-11-12 |
| 1134406184 | Amanda Dawn Peacock | Nurse Practitioner | 368 Fell St, San Francisco, CA 94102-5144 | 2011-11-04 |
| Street Address |
3 SHIRCLIFF WAY SUITE 714 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32204-4757 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255336350 | Walter R Gilbert Jr Md Pa | Clinic/Center | 3 Shircliff Way, Ste 122, Jacksonville, FL 32204-4757 | 2005-06-15 |
| 1720602535 | Kristen Marquardt | Nurse Practitioner | 3 Shircliff Way, Dillon Building Suite 625, Jacksonville, FL 32204 | 2020-06-08 |
| 1851713887 | Janet A Betchkal Md Pa | Ophthalmology | 3 Shircliff Way, Suite 134, Jacksonville, FL 32204-4757 | 2014-01-10 |
| 1093089716 | Jennifer Farhat Marzoug | Nurse Practitioner | 3 Shircliff Way, Suite 400, Jacksonville, FL 32204-4757 | 2012-02-27 |
| 1962709311 | William Alexander Evans | Pharmacist | 3 Shircliff Way, Jacksonville, FL 32204-4757 | 2011-02-22 |
| 1881912061 | Taolin C Jen Md Pa | Clinic/Center | 3 Shircliff Way, Suite 614, Jacksonville, FL 32204-4776 | 2010-05-12 |
| 1124273529 | Sunshine Spine and Pain, Pa | Physical Medicine & Rehabilitation | 3 Shircliff Way, Suite 610, Jacksonville, FL 32204-4757 | 2008-11-26 |
| 1013161223 | Mielke Group, Inc. | Clinical Neuropsychologist | 3 Shircliff Way, Suite #333, Jacksonville, FL 32204-4757 | 2008-11-14 |
| 1215189238 | George L Mayer Md | Obstetrics & Gynecology | 3 Shircliff Way, Suite 625, Jacksonville, FL 32204-4757 | 2008-10-22 |
| 1033366273 | Bruce A Hartwig Md Pa | Specialist | 3 Shircliff Way, Suite 752, Jacksonville, FL 32204-4730 | 2008-08-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437719853 | North Florida Surgeons, Pa | Orthopaedic Surgery | 2 Shirlciff Ways, Suite 300, Jacksonville, FL 32204 | 2019-06-18 |
| 1770043531 | Manuel Viado Rosas | Physical Therapist | Bold City Therapy and Wellness LLC, 2054 Park Street, Jacksonville, FL 32204 | 2019-03-20 |
| 1255805172 | Tracie Nickole Singh | Marriage & Family Therapist | 1125 W Beaver Street, Suite 205, Jacksonville, FL 32204 | 2019-01-14 |
| 1427548544 | Bold City Therapy and Wellness LLC | Clinic/Center | 2054 Park Street, Jacksonville, FL 32204 | 2018-05-14 |
| 1356883078 | Lcn Enterprise, LLC | Case Manager/Care Coordinator | 1225 W Beaver St Ste 106, Jacksonville, FL 32204 | 2016-11-11 |
| 1073065082 | Prosser and Prosser LLC | Non-emergency Medical Transport (VAN) | 2120 Ernest St, Jacksonville, FL 32204 | 2016-10-26 |
| 1336529817 | Nader Daoud | Internal Medicine | 1 Shircliffway, Jacksonville, FL 32204 | 2015-06-01 |
| 1194119214 | Benjamin James Dionne | Internal Medicine | 2 Shircliff Way Ste 400, Jacksonville, FL 32204 | 2015-03-26 |
| 1598187932 | Jamara Stephens | Counselor | 1225 W Beaver St Ste 205, Jacksonville, FL 32204 | 2014-01-18 |
| 1154743961 | Kathleen Jasper | Nurse Anesthetist, Certified Registered | 2165 Herschel Street, Jacksonville, FL 32204 | 2014-01-14 |
| Find all providers in zip 32204 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306443916 | Simmy Regin Varghese | Nurse Practitioner | 1613 Hammock Grove Ln, Jacksonville, FL 32225-5575 | 2020-10-06 |
| 1265917124 | Sandra Jayussi | Nurse Practitioner | 7406 Fullerton Ave, Jacksonville, FL 32256 | 2018-09-26 |
| 1427563980 | William Phillips | Nurse Practitioner | 1325 San Marco Blvd Bldg Suite300, Jacksonville, FL 32207-8568 | 2017-12-06 |
| 1366977902 | Annette Faulkner Wall | Nurse Practitioner | 14601 Swansea Ct, Jacksonville, FL 32258-4446 | 2017-04-20 |
| 1730457565 | Tressie Brooks | Nurse Practitioner | 4203 Belfort Rd Ste 108, Jacksonville, FL 32216-1411 | 2011-12-07 |
| 1346563129 | Brooke Leigh Mcduffie | Nurse Practitioner | 3115 Spring Glen Rd, Suite 505, Jacksonville, FL 32207-5978 | 2010-03-08 |
| 1558536490 | Jacquelyn Danette Cannon | Nurse Practitioner | 1200 Riverplace Blvd 620, Jacksonville, FL 32207-1803 | 2008-04-22 |
| 1003969627 | Mike J Primeaux | Nurse Practitioner | 10601 San Jose Blvd Ste 208, Jacksonville, FL 32257-8203 | 2007-01-18 |
| 1700819372 | Paula F New | Nurse Practitioner | 3221 Henderson Dr, Jacksonville, NC 28546-5251 | 2006-07-08 |
| 1114972841 | Roxanna A Mcdonald | Nurse Practitioner | 1947 Morningside St, Jacksonville, FL 32205-9390 | 2006-05-23 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32204 |
Please comment or provide details below to improve the information on AMANDA B PEACOCK.
| 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.