Provider Demographics
NPI:1811172836
Name:SCHERTZ, JAZZCELYN L (DNP)
Entity type:Individual
Prefix:
First Name:JAZZCELYN
Middle Name:L
Last Name:SCHERTZ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MS
Other - First Name:JAZZCELYN
Other - Middle Name:GOMEZ
Other - Last Name:LOLENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:228 EGRET CT
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3259
Mailing Address - Country:US
Mailing Address - Phone:618-792-8051
Mailing Address - Fax:
Practice Address - Street 1:15740 S OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2004
Practice Address - Country:US
Practice Address - Phone:636-735-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006430364SF0001X
MO2018022344363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209006430Medicaid
IL209006430Medicaid