MEDICARE: SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1134082753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN BAPTIST HOSPITAL OF FLORIDA, INC

Provider Business Mailing Address
First Line	:	1350 13TH AVE S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3203
Country	:	US
Telephone Number	:	904-202-2555
Fax Number	:	904-618-2222

Provider Business Practice Location Address
First Line	:	1235 SAN MARCO BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8554
Country	:	US
Telephone Number	:	904-202-2555
Fax Number	:	904-618-2222

Authorized Official
Title or Position	:	SYSTEM PHARMACY EXECUTIVE
Name	:	DR. KEITH RICHARD SCHISSLER
Credential	:	PHARMD
Telephone Number	:	904-627-2934

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	05/27/2026

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