MEDICARE: MRS. GIAVONNI BEATRICE PEGUERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	2025039553	GA

General Provider Information

NPI Number	:	1538009816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GIAVONNI BEATRICE PEGUERO

Provider Business Mailing Address
First Line	:	7382 SAN ISIDRO RD APT A
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31315-1272
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7382 SAN ISIDRO RD APT A
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31315-1272
Country	:	US
Telephone Number	:	912-255-2024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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