Provider Demographics
NPI:1740581230
Name:PETERS, JUDY (MS)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7074 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8658
Mailing Address - Country:US
Mailing Address - Phone:352-540-9335
Mailing Address - Fax:352-544-5904
Practice Address - Street 1:7074 GROVE RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34609-8658
Practice Address - Country:US
Practice Address - Phone:352-540-9335
Practice Address - Fax:352-544-5904
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator