Provider Demographics
NPI:1053201038
Name:PEGUERO, JANELLE ALEXANDRA
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:ALEXANDRA
Last Name:PEGUERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16097 TUSCANY HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2789
Mailing Address - Country:US
Mailing Address - Phone:813-532-6576
Mailing Address - Fax:
Practice Address - Street 1:16097 TUSCANY HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2789
Practice Address - Country:US
Practice Address - Phone:813-532-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040639363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner