Provider Demographics
NPI:1831461516
Name:PECK, OSTILE FOUCAULT (ARNP)
Entity Type:Individual
Prefix:
First Name:OSTILE
Middle Name:FOUCAULT
Last Name:PECK
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 1:9514 SNOWBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:813-263-5712
Mailing Address - Fax:813-406-5994
Practice Address - Street 1:9514 SNOWBERRY WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3652
Practice Address - Country:US
Practice Address - Phone:813-263-5712
Practice Address - Fax:813-406-5994
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9259099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner