Healthcare Provider Details

I. General information

NPI: 1679114813
Provider Name (Legal Business Name): PEGGY HOLLY WOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2019
Last Update Date: 03/25/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 BAYWOODS DR
PENSACOLA FL
32504-6804
US

IV. Provider business mailing address

4601 BAYWOODS DR
PENSACOLA FL
32504-6804
US

V. Phone/Fax

Practice location:
  • Phone: 904-476-5879
  • Fax: 448-400-4234
Mailing address:
  • Phone: 904-476-5879
  • Fax: 448-400-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-100073
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-57745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: