Provider Demographics
NPI:1386674505
Name:LADD, PEGGY (ARNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:LADD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-3239
Mailing Address - Country:US
Mailing Address - Phone:352-463-6292
Mailing Address - Fax:352-463-4507
Practice Address - Street 1:821 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3238
Practice Address - Country:US
Practice Address - Phone:352-463-6292
Practice Address - Fax:352-463-4507
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1569032363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58539OtherBC
FLARNP1569032OtherMEDICAL LICENSE
FL307483800Medicaid
FL101936Medicare ID - Type UnspecifiedUGS MC
FL307483800Medicaid