Healthcare Provider Details

I. General information

NPI: 1528748043
Provider Name (Legal Business Name): ASHLEY NICOLE SNYDER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S GREENFIELD RD STE 101
MESA AZ
85206-5505
US

IV. Provider business mailing address

1080 E ROSEBUD DR
SAN TAN VALLEY AZ
85143-6328
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-5800
  • Fax:
Mailing address:
  • Phone: 219-775-9677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN195997
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number297024
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: