Healthcare Provider Details

I. General information

NPI: 1548287147
Provider Name (Legal Business Name): LAURA SNYDER P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4771 S CLEVELAND AVE
FORT MYERS FL
33907-1317
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9800
  • Fax: 239-343-9848
Mailing address:
  • Phone: 239-343-9800
  • Fax: 239-343-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2005030570
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2005030570
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: