1770530180 NPI number — MS. JENNIFER LYN SCHOOK PA-C

Table of content: MS. JENNIFER LYN SCHOOK PA-C (NPI 1770530180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770530180 NPI number — MS. JENNIFER LYN SCHOOK PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOOK
Provider First Name:
JENNIFER
Provider Middle Name:
LYN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MESSER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770530180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6251 SAWYER LOOP RD APT 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34238-3153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-957-8161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2830 BEE RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34239-7115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-927-1234
Provider Business Practice Location Address Fax Number:
941-921-0043
Provider Enumeration Date:
05/30/2006

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: 363AM0700X , with the licence number:  0110001942 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA9104673 , 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: 010206944 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010206910 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010206863 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".