Provider Demographics
NPI:1750315263
Name:VAN SCHAICK, JILL LOUISE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LOUISE
Last Name:VAN SCHAICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:LOUISE
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:12902 MAGNOLIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:888-860-2778
Mailing Address - Fax:813-745-4226
Practice Address - Street 1:12902 MAGNOLIA DRIVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:888-860-2778
Practice Address - Fax:813-745-4226
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9215820363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY064QOtherBLUE CROSS BLE SHIELD
FL306666500Medicaid
FLP00186985Medicare PIN
FLQ33729Medicare UPIN
FLY064QZMedicare PIN