Provider Demographics
NPI:1730578055
Name:SCHWARTZ, VICKY SUSAN (APRN)
Entity type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:SUSAN
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 FIORI DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-9522
Mailing Address - Country:US
Mailing Address - Phone:850-358-0092
Mailing Address - Fax:
Practice Address - Street 1:6025 FIORI DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-9522
Practice Address - Country:US
Practice Address - Phone:850-358-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9314175163W00000X
AK37289163W00000X
AK1513363LA2200X
FLAPRN9314175363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse