Provider Demographics
NPI:1093609547
Name:PECK, TIA ANGELE
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:ANGELE
Last Name:PECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9636 W TAMS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-8962
Mailing Address - Country:US
Mailing Address - Phone:504-931-3694
Mailing Address - Fax:
Practice Address - Street 1:3708 MAYFAIR ST STE 110
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6223
Practice Address - Country:US
Practice Address - Phone:984-215-5090
Practice Address - Fax:984-215-5095
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program