Healthcare Provider Details

I. General information

NPI: 1932809183
Provider Name (Legal Business Name): FAITH ANN PEATS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N CLYDE MORRIS BLVD STE 510
DAYTONA BEACH FL
32114-2757
US

IV. Provider business mailing address

PO BOX 100286
GAINESVILLE FL
32610-2911
US

V. Phone/Fax

Practice location:
  • Phone: 386-241-1020
  • Fax:
Mailing address:
  • Phone: 352-265-0761
  • Fax: 352-265-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND4992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: