Healthcare Provider Details

I. General information

NPI: 1093069676
Provider Name (Legal Business Name): NATALIE J SNODGRASS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 NW 86TH TER
GAINESVILLE FL
32606-9277
US

IV. Provider business mailing address

PO BOX 13833
PHILADELPHIA PA
19101-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-4357
  • Fax:
Mailing address:
  • Phone: 352-265-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME50107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: