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General NPI Number Information
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NPI Number | 1578826954
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Entity Type | Individual
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Provider Name | PEGGY ANN CORDLE ARNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 1229 S MYRTLE AVE
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City | CLEARWATER
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State | FL
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Zip | 33756-3469
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Country | US
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Telephone | 727-403-5380
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Fax |
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Provider Business Mailing Address
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Address Line | 420 18TH AVE
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City | INDIAN ROCKS BEACH
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State | FL
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Zip | 33785-2922
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Country | US
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Telephone | 727-560-4232
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN9285219
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License Number State | FL
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