Provider Demographics
NPI:1265858666
Name:SCHANNNAULT, HERMAN
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:
Last Name:SCHANNNAULT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HERMAN
Other - Middle Name:JEROME
Other - Last Name:SCHANNAULT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1400 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-4470
Mailing Address - Country:US
Mailing Address - Phone:561-445-9026
Mailing Address - Fax:561-395-8499
Practice Address - Street 1:1400 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-4470
Practice Address - Country:US
Practice Address - Phone:561-445-9026
Practice Address - Fax:561-395-8499
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2632452363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health