MEDICARE: JASON SNADER ATC

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	2255A2300X	Athletic Trainer	2000020534	FL

General Provider Information

NPI Number	:	1528441730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON SNADER ATC

Provider Business Mailing Address
First Line	:	152 WINDERMERE WAY
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32095-7558
Country	:	US
Telephone Number	:	717-917-1581
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 N MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-1450
Country	:	US
Telephone Number	:	717-917-1581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	11/26/2025

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