Provider Demographics
NPI:1730246810
Name:PEGG, NANCY H (MSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:H
Last Name:PEGG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2066
Mailing Address - Country:US
Mailing Address - Phone:772-567-3981
Mailing Address - Fax:
Practice Address - Street 1:2704 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2066
Practice Address - Country:US
Practice Address - Phone:772-567-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00001081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7476Medicare ID - Type UnspecifiedSOCIAL WORK