Healthcare Provider Details

I. General information

NPI: 1568448751
Provider Name (Legal Business Name): JENNIFER KEESE SCHANTZ CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/10/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 MASSEY AVE BUILDING 2104
JACKSONVILLE FL
32228
US

IV. Provider business mailing address

1015 ATLANTIC BLVD STE 264
ATLANTIC BEACH FL
32233-3313
US

V. Phone/Fax

Practice location:
  • Phone: 904-270-4270
  • Fax:
Mailing address:
  • Phone: 360-607-6765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number9457444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: