Healthcare Provider Details

I. General information

NPI: 1457732885
Provider Name (Legal Business Name): ALEXANDRA SNODGRASS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA OWENS MD

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 05/02/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD SHANDS HOSPITAL, ROOM 4102
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1850 TOWN CENTER PWKY UNIT 551
RESTON VA
20190
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0239
  • Fax: 352-265-1107
Mailing address:
  • Phone: 703-481-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0088444
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTRN22091
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101268348
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: