Provider Demographics
NPI:1740523893
Name:PELOQUIN, ROBERT (RN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PELOQUIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SARNO RD
Mailing Address - Street 2:#108
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4938
Mailing Address - Country:US
Mailing Address - Phone:321-421-1521
Mailing Address - Fax:321-421-1520
Practice Address - Street 1:1600 SARNO RD
Practice Address - Street 2:#108
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4938
Practice Address - Country:US
Practice Address - Phone:321-421-1521
Practice Address - Fax:321-421-1520
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9213975163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse