Provider Demographics
NPI:1578788287
Name:SCHROEDER, REGINA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 SWEETGRASS PL UNIT 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0131
Mailing Address - Country:US
Mailing Address - Phone:904-367-3372
Mailing Address - Fax:904-990-1551
Practice Address - Street 1:1633 RACE TRACK RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3237
Practice Address - Country:US
Practice Address - Phone:904-230-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9118245363A00000X
CAPA 12615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 12615OtherLICENSE NUMBER