Provider Demographics
NPI:1972723898
Name:SCHULTZ, IDA F (LPN)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:F
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:IDA
Other - Middle Name:F
Other - Last Name:PASSMORE SCHULTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30244 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544
Mailing Address - Country:US
Mailing Address - Phone:813-973-3989
Mailing Address - Fax:
Practice Address - Street 1:37922 MEDICAL ARTS COURT
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541
Practice Address - Country:US
Practice Address - Phone:352-518-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN364621164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse