Provider Demographics
NPI:1316375041
Name:PEACH, JONATHAN (DNP, ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PEACH
Suffix:
Gender:M
Credentials:DNP, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2768 W LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3524
Mailing Address - Country:US
Mailing Address - Phone:407-878-3208
Mailing Address - Fax:407-734-2898
Practice Address - Street 1:2768 W LAKE MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3524
Practice Address - Country:US
Practice Address - Phone:407-878-3208
Practice Address - Fax:321-234-0229
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9288493363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily