MEDICARE: MR. PETER CHRISTOPHER MCDERMOTT ARNP

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	363L00000X	Nurse Practitioner	APRN9320434	FL

General Provider Information

NPI Number	:	1396282836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER CHRISTOPHER MCDERMOTT ARNP

Provider Business Mailing Address
First Line	:	4320 DEERWOOD LAKE PKWY
Second Line	:	327
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1177
Country	:	US
Telephone Number	:	904-226-1496
Fax Number	:	904-458-8720

Provider Business Practice Location Address
First Line	:	3874 SAN JOSE PARK DR STE 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4660
Country	:	US
Telephone Number	:	904-799-2531
Fax Number	:	904-659-8558

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

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	02/16/2026

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