Provider Demographics
NPI:1063936284
Name:OGDEN, SCHACARRA ANN (PROVIDER)
Entity type:Individual
Prefix:MS
First Name:SCHACARRA
Middle Name:ANN
Last Name:OGDEN
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9058 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2225
Mailing Address - Country:US
Mailing Address - Phone:904-258-6309
Mailing Address - Fax:
Practice Address - Street 1:9545 WAYNESBORO AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-1147
Practice Address - Country:US
Practice Address - Phone:904-258-6309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-30
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234956376J00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemaker
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL821755389Medicaid