Provider Demographics
NPI:1821684697
Name:SCHWARZ, KEA M (RD)
Entity Type:Individual
Prefix:
First Name:KEA
Middle Name:M
Last Name:SCHWARZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 HUNTERS HILL E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-3819
Mailing Address - Country:US
Mailing Address - Phone:305-332-4148
Mailing Address - Fax:
Practice Address - Street 1:2913 HUNTERS HILL E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-3819
Practice Address - Country:US
Practice Address - Phone:305-332-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9864133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered