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General NPI Number Information
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NPI Number | 1942679683
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Entity Type | Individual
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Provider Name | TERESA E PEAK PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 4950 34TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33714-3031
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Country | US
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Telephone | 727-824-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 14100 58TH ST N
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City | CLEARWATER
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State | FL
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Zip | 33760-9900
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Country | US
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Telephone | 172-750-3534
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Fax | 727-895-3762
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9109039
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License Number State | FL
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