Provider Demographics
NPI:1528200813
Name:PEACOCK, JANINE DANETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:DANETTE
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2850
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-3053
Mailing Address - Country:US
Mailing Address - Phone:480-474-6100
Mailing Address - Fax:480-888-0679
Practice Address - Street 1:32375 N GANTZEL RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5110
Practice Address - Country:US
Practice Address - Phone:480-474-6100
Practice Address - Fax:480-888-0679
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN154296163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool