Provider Demographics
NPI:1447326202
Name:SCHWARZ, PAMELA ANNE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:SCHWARZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 WATER CREST DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7224
Mailing Address - Country:US
Mailing Address - Phone:904-703-5553
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 1304
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6297
Practice Address - Country:US
Practice Address - Phone:904-703-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38740225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist