=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063792653
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN FREDRICK SCHAMAUN ARNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2011
-----------------------------------------------------
Last Update Date | 04/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38135 MARKET SQ
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33542-7505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-567-0188
-----------------------------------------------------
Fax | 813-355-5101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 18344
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33679-8344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-874-5500
-----------------------------------------------------
Fax | 813-874-5500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9233664
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------