Healthcare Provider Details

I. General information

NPI: 1396612982
Provider Name (Legal Business Name): JUSTIN SNYDER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 SOULE RD
CLEARWATER FL
33759-1507
US

IV. Provider business mailing address

1938 SOULE RD
CLEARWATER FL
33759-1507
US

V. Phone/Fax

Practice location:
  • Phone: 727-726-7442
  • Fax: 727-288-1111
Mailing address:
  • Phone: 727-726-7442
  • Fax: 727-288-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11043807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: