Provider Demographics
NPI:1811394828
Name:PEACOCK, ALICIA NICOLE (FNP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:NICOLE
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9686 MEEKER ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-8477
Mailing Address - Country:US
Mailing Address - Phone:970-389-9800
Mailing Address - Fax:
Practice Address - Street 1:405 URBAN ST STE 320
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1222
Practice Address - Country:US
Practice Address - Phone:207-719-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily