MEDICARE: AMY NICOLE PEACOCK FNP-C

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	AP5048	AZ

General Provider Information

NPI Number	:	1548609530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY NICOLE PEACOCK FNP-C

Provider Business Mailing Address
First Line	:	1728 W GLENDALE AVE STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8862
Country	:	US
Telephone Number	:	623-299-8251
Fax Number	:	623-299-8226

Provider Business Practice Location Address
First Line	:	1728 W GLENDALE AVE STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8862
Country	:	US
Telephone Number	:	623-299-8251
Fax Number	:	623-299-8226

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

Provider Enumeration Date	:	06/23/2013
Last Update Date	:	05/04/2026

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