Provider Demographics
NPI:1780054403
Name:PEAK, DAPHNIE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:DAPHNIE
Middle Name:
Last Name:PEAK
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST. JOHN URGENT CARE, 1717 S. UTICA AVE.
Mailing Address - Street 2:#A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104
Mailing Address - Country:US
Mailing Address - Phone:918-748-1300
Mailing Address - Fax:
Practice Address - Street 1:ST. JOHN URGENT CARE, 1717 S. UTICA AVE.
Practice Address - Street 2:#A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-748-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily