Healthcare Provider Details

I. General information

NPI: 1063936284
Provider Name (Legal Business Name): SCHACARRA ANN OGDEN PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2017
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9545 WAYNESBORO AVE
JACKSONVILLE FL
32208-1147
US

IV. Provider business mailing address

9058 JEFFERSON AVE
JACKSONVILLE FL
32208-2225
US

V. Phone/Fax

Practice location:
  • Phone: 904-258-6309
  • Fax:
Mailing address:
  • Phone: 904-258-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number234956
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number234956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: