Healthcare Provider Details

I. General information

NPI: 1114239324
Provider Name (Legal Business Name): LESLEY A. MCPEAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76011 WILLIAM BURGESS BLVD
YULEE FL
32097-5428
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-427-8583
  • Fax:
Mailing address:
  • Phone: 904-244-3566
  • Fax: 904-244-9540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME132802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: