Provider Demographics
NPI:1548609530
Name:PEACOCK, AMY NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N SENATE ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1938
Mailing Address - Country:US
Mailing Address - Phone:802-963-3544
Mailing Address - Fax:480-789-7894
Practice Address - Street 1:16240 N FORT MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:FORT MCDOWELL
Practice Address - State:AZ
Practice Address - Zip Code:85264-3402
Practice Address - Country:US
Practice Address - Phone:480-789-7890
Practice Address - Fax:480-789-7890
Is Sole Proprietor?:No
Enumeration Date:2013-06-23
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily