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General NPI Number Information
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NPI Number | 1083736755
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Entity Type | Individual
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Provider Name | THERESA PEACOCK NP
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 2581 EL CAMINO AVENUE SUITE 101
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City | LAS VEGAS
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State | NV
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Zip | 89102
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Country | US
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Telephone | 702-380-3210
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Fax | 702-380-3212
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Provider Business Mailing Address
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Address Line | 2851 EL CAMINO AVE
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City | LAS VEGAS
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State | NV
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Zip | 89102-4266
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Country | US
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Telephone | 702-380-3210
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Fax | 702-380-3212
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN67339
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024167292
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN001542
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License Number State | NV
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