Healthcare Provider Details

I. General information

NPI: 1265355143
Provider Name (Legal Business Name): PEREGRINE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 PEREGRINE DR
INDIALANTIC FL
32903-4738
US

IV. Provider business mailing address

162 PEREGRINE DR
INDIALANTIC FL
32903-4738
US

V. Phone/Fax

Practice location:
  • Phone: 321-300-4929
  • Fax:
Mailing address:
  • Phone: 321-300-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLA MEZA
Title or Position: FOUNDER / CEO
Credential: DNP
Phone: 321-960-8654