Provider Demographics
NPI:1700057379
Name:SCHNEIDER, KELLEY ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:ANN
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-2809
Mailing Address - Country:US
Mailing Address - Phone:904-633-0640
Mailing Address - Fax:904-633-0611
Practice Address - Street 1:6015 118TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-3703
Practice Address - Country:US
Practice Address - Phone:904-633-6010
Practice Address - Fax:904-633-0611
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9377982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9377982OtherAPRN LICENSE