MEDICARE: MS. GLORIA ANNE PEAK FNP

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	363LF0000X	Family Nurse Practitioner	NP10745	CA

General Provider Information

NPI Number	:	1376639179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLORIA ANNE PEAK FNP

Provider Business Mailing Address
First Line	:	18077 US HIGHWAY 18
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-2197
Country	:	US
Telephone Number	:	760-946-8169
Fax Number	:	760-946-8875

Provider Business Practice Location Address
First Line	:	18077 US HIGHWAY 18
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-2197
Country	:	US
Telephone Number	:	760-946-8169
Fax Number	:	760-946-8875

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	09/04/2025

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