Basic Information
| Provider Information | |||||||||
| NPI: | 1386674505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LADD | ||||||||
| FirstName: | PEGGY | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326933239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524636292 | ||||||||
| FaxNumber: | 3524634507 | ||||||||
| Practice Location | |||||||||
| Address1: | 821 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326933238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524636292 | ||||||||
| FaxNumber: | 3524634507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 09/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | ARNP1569032 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 58539 | 01 | FL | BC | OTHER | ARNP1569032 | 01 | FL | MEDICAL LICENSE | OTHER | 307483800 | 05 | FL | MEDICAID |