MEDICARE: SCOTT PETERS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	574711-1	NY
2	363LA2100X	Acute Care Nurse Practitioner	11031606	FL

General Provider Information

NPI Number	:	1205468642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT PETERS APRN

Provider Business Mailing Address
First Line	:	PO BOX 935921
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-5921
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 MEMORIAL MEDICAL PKWY STE 1-800B
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5983
Country	:	US
Telephone Number	:	386-586-1970
Fax Number	:	386-586-1971

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	07/18/2024

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Directions to “ SCOTT PETERS APRN” Practice Location

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