DR. POLLY WIETZKE PETERSON


Address: 1555 Kingsley Ave, Orange Park, FL 32073-9201
Phone: 9042784999

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TS0200X Psychologist
Specialization: School
SS495 FL Behavioral Health & Social Service Providers

Other Provider Identifier

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

Other Providers POLLY PETERSON

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

Office Location

Street Address 1555 KINGSLEY AVE
City ORANGE PARK
State FL
Zip Code 32073-9201

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 103TS0200X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization School

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
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
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Competitor

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City ORANGE PARK
Zip Code 32073

Improve Information

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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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