Healthcare Provider Details

I. General information

NPI: 1134082753
Provider Name (Legal Business Name): SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 SAN MARCO BLVD
JACKSONVILLE FL
32207-8554
US

IV. Provider business mailing address

1350 13TH AVE S
JACKSONVILLE BEACH FL
32250-3203
US

V. Phone/Fax

Practice location:
  • Phone: 904-627-2934
  • Fax: 904-618-2222
Mailing address:
  • Phone: 904-627-2934
  • Fax: 904-618-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH RICHARD SCHISSLER
Title or Position: SYSTEM PHARMACY EXECUTIVE
Credential: PHARMD
Phone: 904-627-2934