Healthcare Provider Details

I. General information

NPI: 1336772474
Provider Name (Legal Business Name): EMILY SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 EXECUTIVE DR
NAPLES FL
34119-9033
US

IV. Provider business mailing address

PO BOX 110820
NAPLES FL
34108-0114
US

V. Phone/Fax

Practice location:
  • Phone: 239-248-7819
  • Fax:
Mailing address:
  • Phone: 239-591-2803
  • Fax: 239-594-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11005934
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11005934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: