Provider Demographics
NPI:1376835991
Name:KLEIN, PEGGY WILDS (ARNP-C)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:WILDS
Last Name:KLEIN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4673 ANSON LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6074
Mailing Address - Country:US
Mailing Address - Phone:407-687-4302
Mailing Address - Fax:
Practice Address - Street 1:2572 W STATE ROAD 426
Practice Address - Street 2:SUITE 3056
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8389
Practice Address - Country:US
Practice Address - Phone:407-706-6580
Practice Address - Fax:407-706-6586
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-15
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9171124363LA2200X
FLRN9171124364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1376835991Medicare UPIN
FL46507FLMedicare PIN
FLEI427AOtherPECOS