Healthcare Provider Details

I. General information

NPI: 1275719890
Provider Name (Legal Business Name): JASON DAVID SCHOTTEL ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 DUNLAWTON AVE STE 104
PORT ORANGE FL
32127
US

IV. Provider business mailing address

851 DUNLAWTON AVE STE 104
PORT ORANGE FL
32127-4234
US

V. Phone/Fax

Practice location:
  • Phone: 904-333-4031
  • Fax:
Mailing address:
  • Phone: 904-333-4031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12138
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number9176378
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11000698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: