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General NPI Number Information
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NPI Number | 1093684177
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Entity Type | Individual
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Provider Name | TONI LYNN PEACOCK
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Gender | Female
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 3123 LYNNY LN
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City | MARIANNA
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State | FL
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Zip | 32446-6862
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Country | US
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Telephone | 850-718-7585
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Fax | 850-718-7585
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Provider Business Mailing Address
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Address Line | 2587 HEAVENLY DR
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City | MARIANNA
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State | FL
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Zip | 32448-6625
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Country | US
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Telephone | 850-718-7585
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Fax | 850-718-7585
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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 | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | A-09-32-3123
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License Number State | FL
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