Provider Demographics
NPI:1699847152
Name:PECK, TERESA ANNE (CRNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
Last Name:PECK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 WHITE BRIDGE RD # 103-243
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1444
Mailing Address - Country:US
Mailing Address - Phone:615-673-6737
Mailing Address - Fax:800-474-4039
Practice Address - Street 1:6984 PINE FOREST RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-8908
Practice Address - Country:US
Practice Address - Phone:615-673-6737
Practice Address - Fax:800-474-4039
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-1079730363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner