MEDICARE: JENNIFER J. PEACOCK DNP, APRN, NNP-BC

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	364SN0000X	Neonatal Clinical Nurse Specialist	289188-4405	UT

General Provider Information

NPI Number	:	1336513704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER J. PEACOCK DNP, APRN, NNP-BC

Provider Business Mailing Address
First Line	:	100 N MARIO CAPECCHI DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84113-1103
Country	:	US
Telephone Number	:	801-662-4100
Fax Number	:	801-662-4166

Provider Business Practice Location Address
First Line	:	2818 W 12875 S
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-6837
Country	:	US
Telephone Number	:	801-232-6595
Fax Number	:

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

Provider Enumeration Date	:	11/22/2015
Last Update Date	:	09/29/2021

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