Provider Demographics
NPI:1578059309
Name:PEACOCK, LISA LYNN3
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN3
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LYNNE
Other - Last Name:PEABODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 E ADAMS ST STE 210
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3356
Mailing Address - Country:US
Mailing Address - Phone:904-265-1810
Mailing Address - Fax:
Practice Address - Street 1:10423 CENTURION PKWY N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0527
Practice Address - Country:US
Practice Address - Phone:904-854-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-04
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator