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General NPI Number Information
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NPI Number | 1386674505
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Entity Type | Individual
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Provider Name | PEGGY LADD ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 821 S MAIN ST
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City | TRENTON
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State | FL
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Zip | 32693-3238
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Country | US
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Telephone | 352-463-6292
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Fax | 352-463-4507
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Provider Business Mailing Address
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Address Line | 911 S MAIN ST
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City | TRENTON
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State | FL
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Zip | 32693-3239
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Country | US
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Telephone | 352-463-6292
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Fax | 352-463-4507
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | ARNP1569032
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License Number State | FL
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