Provider Demographics
NPI:1104290378
Name:SCHWARTZ, TAKESHANICOLE MARY (APRN)
Entity type:Individual
Prefix:
First Name:TAKESHANICOLE
Middle Name:MARY
Last Name:SCHWARTZ
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10627 DAWNS LIGHT DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-6107
Mailing Address - Country:US
Mailing Address - Phone:417-619-0660
Mailing Address - Fax:
Practice Address - Street 1:7777 131ST ST STE 14
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-4015
Practice Address - Country:US
Practice Address - Phone:813-680-1600
Practice Address - Fax:813-430-0942
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9327592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily