DR. POLLY WIETZKE PETERSON (NPI# 1902929698) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1902929698 |
Entity Type | Individual |
Full Name | DR. POLLY WIETZKE PETERSON |
Credential | PH.D. |
Practice Address |
1555 Kingsley Ave Orange Park FL 32073-9201 |
Mailing Address |
1543 Kingsley Ave Ste 14 Orange Park FL 32073-4570 |
Practice Telephone | 9042784999 |
Practice Fax Number | 9042788891 |
Mailing Telephone | 9043759679 |
Mailing Fax Number | 9042690870 |
Enumeration Date | 2007-04-09 |
Last Update Date | 2020-07-28 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 103TS0200X |
Psychologist Specialization: School |
SS495 | FL | Behavioral Health & Social Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
FL | US DEPARTMENT OF LABOR | 346340500 | 01 |
FL | BLUE CROSS BLUE SHIELD FL | Z0537 | 01 |
FL | BLUE CROSS BLUE SHIELD FL | Z8341 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316324700 | Polly Peterson | Psychologist | 125 W Granite St Ste 212, Butte, MT 59701-9215 | 2015-05-05 |
1740340678 | Polly A Peterson | Counselor | 1406 E Franklin St, Boise, ID 83712-7404 | 2006-12-11 |
Street Address |
1555 KINGSLEY AVE |
City | ORANGE PARK |
State | FL |
Zip Code | 32073-9201 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720084577 | Jack E Cohen | Orthopaedic Surgery | 1555 Kingsley Ave, Ste 201, Orange Park, FL 32073-9202 | 2005-06-27 |
1699137182 | First Coast Pediatric Infectious Disease LLC | Internal Medicine | 1555 Kingsley Ave, Ste. 201, Orange Park, FL 32073-4560 | 2016-03-23 |
1649650771 | Melisia R Robinson | Nurse Practitioner | 1555 Kingsley Ave, 201-202, Orange Park, FL 32073-4560 | 2015-06-03 |
1023404290 | Renee Lehosit | Physical Therapist | 1555 Kingsley Ave, Orange Park, FL 32073-4560 | 2015-04-14 |
1306269741 | Joseph William Phillips | Nurse Practitioner | 1555 Kingsley Ave, Suite 201, Orange Park, FL 32073 | 2014-01-21 |
1861814063 | Prime Care Dental Center,pa | Clinic/Center | 1555 Kingsley Ave, Suite 306, Orange Park, FL 32073-4560 | 2014-01-08 |
1477803849 | Peter J. Pitocchi Md Pa | Internal Medicine | 1555 Kingsley Ave, Ste 501, Orange Park, FL 32073-4560 | 2012-09-13 |
1467702175 | Joan D Oleary Md Pl | Dermatology | 1555 Kingsley Ave, Suite 401, Orange Park, FL 32073-4560 | 2012-09-11 |
1447406467 | Jennifer Roy Ferrer | Counselor | 1555 Kingsley Ave, Suite 406, Orange Park, FL 32073-4560 | 2008-08-10 |
1851556211 | Emanuel Martinez Md and Associates | Psychiatry & Neurology | 1555 Kingsley Ave, Suite 101, Orange Park, FL 32073-4560 | 2008-07-25 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1891309423 | Kingsley Endoscopy Center LLC | Clinic/Center | 970 Kingsley Avenue, Orange Park, FL 32073 | 2020-09-01 |
1962028688 | Esra Sari | Student in an Organized Health Care Education/Training Program | 2001 Kingsley Avenue., Orange Park Medical Center, Orange Park, FL 32073 | 2020-06-18 |
1104441146 | Zeshan Tariq Malik | Student in an Organized Health Care Education/Training Program | 2001 Kingsley Avenue, Office of Graduate Medical Educa, Orange Park, FL 32073 | 2020-06-16 |
1902421894 | Ameer Hamza | Student in an Organized Health Care Education/Training Program | 2001, Kingsley Avenue Office of Graduate Medical Educat, Orange Park, FL 32073 | 2020-06-16 |
1497378103 | Fawad Ahmed Rashid | Student in an Organized Health Care Education/Training Program | 2001 Kingsley Avenue Office of Graduate Medical Educati, Orange Park, FL 32073 | 2020-05-28 |
1477174985 | Hannan Asghar | Student in an Organized Health Care Education/Training Program | Office of Graduate Medical Education 2001 Kingsley, Orange Park, FL 32073 | 2020-05-06 |
1902427156 | Emmanuel Iyanuloluwa Morakinyo | Student in an Organized Health Care Education/Training Program | 413 Deer View Avenue, 2001 Kingsley Ave, Orange Park, FL 32073 | 2020-04-29 |
1437799327 | Dalande Leger | Behavior Technician | 1563 Kingsley Ave Suite 103, Orange Park, FL 32073 | 2020-01-08 |
1215598313 | Mohammad Harisullah Khan | Student in an Organized Health Care Education/Training Program | 2001 Kingsley Ave, Gme Office, Orange Park, FL 32073 | 2019-06-28 |
1558927970 | Preetha Kamath | Student in an Organized Health Care Education/Training Program | Orange Park Medical Center, 2001 Kingsley Ave, Orange Park, FL 32073 | 2019-05-10 |
Find all providers in zip 32073 |
Taxonomy Code | 103TS0200X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Psychologist |
Specialization | School |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194339994 | Jenny Gamble | Psychologist | 33 Knight Boxx Rd # 2, Orange Park, FL 32065-7305 | 2020-08-31 |
1528307212 | Alyssa J Peterson | Psychologist | 748 Briar View Dr, Orange Park, FL 32065-3557 | 2013-01-31 |
NPI | Name | Taxonomy | Address | Enumeration |
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1750980884 | Gihanna Barbara Jimenez | Psychologist | 7301 Sw 57th Ct Ste 565, South Miami, FL 33143-5334 | 2020-10-20 |
1326645177 | Sheila Simchon | Psychologist | 3601 N Park Rd, Hollywood, FL 33021-2529 | 2020-10-05 |
1821602145 | Tamara Shirley | Psychologist | 20755 Sw 86th Pl, Cutler Bay, FL 33189-3841 | 2020-09-03 |
1154934826 | Joseph Ronald Sura | Psychologist | 154 Cunningham Ln, Big Pine Key, FL 33043-4837 | 2020-08-24 |
1871105858 | Bette Dale Garner | Psychologist | 690 Osceola Ave Apt 404, Winter Park, FL 32789-4408 | 2020-08-20 |
1528679156 | Brittany Ubaldini-simon | Psychologist | 8505 Bella Way, Tampa, FL 33635-6005 | 2020-08-17 |
1710598263 | Ramon Delgado Jr. | Psychologist | 10376 Nw 3rd St, Plantation, FL 33324-1702 | 2020-08-10 |
1588274047 | Kristen Rave | Psychologist | 3223 E Community Dr, Jupiter, FL 33458-8217 | 2020-08-08 |
1194334623 | Andrea Latimer | Psychologist | 30953 Water Lily Dr, Brooksville, FL 34602-7740 | 2020-07-30 |
1356966782 | Stacy Zebrick | Psychologist | 10144 Arbor Run Dr Unit 128, Tampa, FL 33647-3570 | 2020-06-11 |
Find all providers with the same taxonomy |
City | ORANGE PARK |
Zip Code | 32073 |
Please comment or provide details below to improve the information on DR. POLLY WIETZKE PETERSON.
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.