Healthcare Provider Details

I. General information

NPI: 1245293588
Provider Name (Legal Business Name): PAUL JAY SNYDER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20745 N SCOTTSDALE RD
SCOTTSDALE AZ
85255-6453
US

IV. Provider business mailing address

4378 E AUSTIN LN
QUEEN CREEK AZ
85240-4389
US

V. Phone/Fax

Practice location:
  • Phone: 480-419-8572
  • Fax: 480-513-0517
Mailing address:
  • Phone: 602-512-4880
  • Fax: 623-321-1736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1850
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: