| A Peaceful Place Integrated Care | |
|
1001 S Bradford St Ste 7 Dover DE 19904-4153 | |
| (302) 264-9436 | |
| (302) 264-9702 |
| Full Name | A Peaceful Place Integrated Care |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1001 S Bradford St Ste 7, Dover, Delaware |
| Authorized Official Name and Position | Ericka Daniel (CEO/PROVIDER) |
| Authorized Official Contact | 3022649436 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Peaceful Place Integrated Care 1211 Ponderosa Dr Magnolia DE 19962 Ph: (302) 233-4652 | A Peaceful Place Integrated Care 1001 S Bradford St Ste 7 Dover DE 19904-4153 Ph: (302) 264-9436 |
| NPI Number | 1801487046 |
|---|---|
| Provider Enumeration Date | 01/31/2021 |
| Last Update Date | 08/31/2023 |
| Certification Date | 08/31/2023 |
| Medicare PECOS PAC ID | 1355742735 |
|---|---|
| Medicare Enrollment ID | O20210622003821 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801487046 | NPI | - | NPPES |
| 1992186142 | Medicaid | DE | |
| LG-0000855 | Other | DE | STATES LICENSE |
| Provider Name | Ericka Daniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992186142 PECOS PAC ID: 6709170913 Enrollment ID: I20160811000782 |
| Provider Name | Nicole Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366974628 PECOS PAC ID: 7113294034 Enrollment ID: I20170525000568 |
| Provider Name | Martona Moody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831481761 PECOS PAC ID: 2365868973 Enrollment ID: I20200813001098 |
| Provider Name | Anthony Agbola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659044204 PECOS PAC ID: 9032503354 Enrollment ID: I20220303000418 |
| Provider Name | Jasmine Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093383747 PECOS PAC ID: 6204228786 Enrollment ID: I20231014000641 |
| Provider Name | Jennifer L Cropper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841357746 PECOS PAC ID: 6901254184 Enrollment ID: I20231128003877 |
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