Basic Information
| Provider Information | |||||||||
| NPI: | 1184844409 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRIGANCE | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 SURGICAL BLVD | ||||||||
| Address2: | STE A | ||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296726654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724653225 | ||||||||
| FaxNumber: | 4794947787 | ||||||||
| Practice Location | |||||||||
| Address1: | 4995 S US HIGHWAY 1 | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349827079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724653225 | ||||||||
| FaxNumber: | 4794947787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2007 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ATP000064 | AR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APN19795APRN | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | ARNP9406424 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 200111100A | 05 | OK | MEDICAID | 164989758 | 05 | AR | MEDICAID |