Healthcare Provider Details

I. General information

NPI: 1548609530
Provider Name (Legal Business Name): AMY NICOLE PEACOCK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2013
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 W HIGHWAY 287
FLORENCE AZ
85132-8170
US

IV. Provider business mailing address

PO BOX 96395
PHOENIX AZ
85072-6395
US

V. Phone/Fax

Practice location:
  • Phone: 520-868-5811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5048
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: