Provider Demographics
NPI:1164479564
Name:SCHELMETY-HENRIQUEZ, LUZ (ARNP, BC)
Entity type:Individual
Prefix:MS
First Name:LUZ
Middle Name:
Last Name:SCHELMETY-HENRIQUEZ
Suffix:
Gender:F
Credentials:ARNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 SW CURRY ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2509
Mailing Address - Country:US
Mailing Address - Phone:772-418-4036
Mailing Address - Fax:
Practice Address - Street 1:1255 SW CURRY ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2509
Practice Address - Country:US
Practice Address - Phone:772-418-4036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3333482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306428000Medicaid