Healthcare Provider Details

I. General information

NPI: 1134639438
Provider Name (Legal Business Name): PEGGY KORTZ BUSH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S KANNER HWY
STUART FL
34994-4622
US

IV. Provider business mailing address

10005 SW TYLER TER
PALM CITY FL
34990-5903
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-2777
  • Fax: 772-219-0017
Mailing address:
  • Phone: 772-872-2789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCNS9363204
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: