Healthcare Provider Details

I. General information

NPI: 1063480069
Provider Name (Legal Business Name): CARY THOMAS SCHULTZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIRCLIFF WAY
JACKSONVILLE FL
32204-4748
US

IV. Provider business mailing address

507 MAJESTIC EAGLE DR
PONTE VEDRA FL
32081-0609
US

V. Phone/Fax

Practice location:
  • Phone: 904-568-4543
  • Fax:
Mailing address:
  • Phone: 910-546-7634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number054263
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number054263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: