1750315263 NPI number — MRS. JILL LOUISE VAN SCHAICK ARNP

Table of content: MRS. JILL LOUISE VAN SCHAICK ARNP (NPI 1750315263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750315263 NPI number — MRS. JILL LOUISE VAN SCHAICK ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN SCHAICK
Provider First Name:
JILL
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLAIR
Provider Other First Name:
JILL
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750315263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12902 MAGNOLIA DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-860-2778
Provider Business Mailing Address Fax Number:
813-745-4226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12902 MAGNOLIA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-860-2778
Provider Business Practice Location Address Fax Number:
813-745-4226
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP9215820 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y064Q . This is a "BLUE CROSS BLE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 306666500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016881100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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