Healthcare Provider Details

I. General information

NPI: 1609653427
Provider Name (Legal Business Name): ELIZABETH ROSE SNYDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 W FLETCHER AVE
TAMPA FL
33612-3366
US

IV. Provider business mailing address

902 PALACIO DE AVILA
TAMPA FL
33613-5224
US

V. Phone/Fax

Practice location:
  • Phone: 813-264-2288
  • Fax:
Mailing address:
  • Phone: 813-928-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN9213860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: