Provider Demographics
NPI:1174804017
Name:SCHNEIDER, JOANNA (ARNP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-7829
Mailing Address - Country:US
Mailing Address - Phone:904-910-3332
Mailing Address - Fax:
Practice Address - Street 1:4161 CARMICHAEL AVE
Practice Address - Street 2:BUILDING 3300, SUITE 152
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2353
Practice Address - Country:US
Practice Address - Phone:904-396-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9323892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174804017OtherNPI: 1174804017