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General NPI Number Information
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NPI Number | 1134639438
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Entity Type | Individual
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Provider Name | PEGGY KORTZ BUSH APN
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Gender | Female
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 2601 S KANNER HWY
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City | STUART
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State | FL
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Zip | 34994-4622
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Country | US
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Telephone | 772-219-2777
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Fax | 772-219-0017
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Provider Business Mailing Address
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Address Line | 10005 SW TYLER TER
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City | PALM CITY
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State | FL
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Zip | 34990-5903
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Country | US
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Telephone | 772-872-2789
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Fax |
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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 | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | CNS9363204
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License Number State | FL
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