Healthcare Provider Details

I. General information

NPI: 1982900106
Provider Name (Legal Business Name): TINA LYNN SNYDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 HURON PEAK AVE
SUPERIOR CO
80027-4628
US

IV. Provider business mailing address

3141 HURON PEAK AVE
SUPERIOR CO
80027-4628
US

V. Phone/Fax

Practice location:
  • Phone: 731-610-7379
  • Fax:
Mailing address:
  • Phone: 731-610-7379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0990703-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number990703
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: