Provider Demographics
NPI:1184844409
Name:BRIGANCE, PEGGY B (FNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:B
Last Name:BRIGANCE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SURGICAL BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-6654
Mailing Address - Country:US
Mailing Address - Phone:772-465-3225
Mailing Address - Fax:479-494-7787
Practice Address - Street 1:4995 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-7079
Practice Address - Country:US
Practice Address - Phone:772-465-3225
Practice Address - Fax:479-494-7787
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARATP000064363LF0000X
SCAPN19795APRN363LF0000X
FLARNP9406424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200111100AMedicaid
AR164989758Medicaid
AR164989758Medicaid
OK200111100AMedicaid