Healthcare Provider Details

I. General information

NPI: 1780024166
Provider Name (Legal Business Name): MARC PEGGY JOSEPH APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 11/16/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 NW 19TH ST
FORT LAUDERDALE FL
33311-3535
US

IV. Provider business mailing address

6428 FLETCHER ST
HOLLYWOOD FL
33023-2130
US

V. Phone/Fax

Practice location:
  • Phone: 786-426-2197
  • Fax:
Mailing address:
  • Phone: 786-426-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9291362
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPRN9291362
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9291362
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN9291362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: