Provider Demographics
NPI:1396282836
Name:MCDERMOTT, PETER CHRISTOPHER (ARNP)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:CHRISTOPHER
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:MR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:4320 DEERWOOD LAKE PKWY
Mailing Address - Street 2:327
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1177
Mailing Address - Country:US
Mailing Address - Phone:904-226-1496
Mailing Address - Fax:904-458-8720
Practice Address - Street 1:1325 SAN MARCO BLVD
Practice Address - Street 2:300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8568
Practice Address - Country:US
Practice Address - Phone:904-253-6910
Practice Address - Fax:904-253-6964
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9320434363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner