Healthcare Provider Details

I. General information

NPI: 1639643828
Provider Name (Legal Business Name): ALEXANDRA SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 E PARK AVE
TALLAHASSEE FL
32301-2653
US

IV. Provider business mailing address

6970 STANDING PINES LN
TALLAHASSEE FL
32312-9675
US

V. Phone/Fax

Practice location:
  • Phone: 850-765-6769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: