Healthcare Provider Details

I. General information

NPI: 1083855340
Provider Name (Legal Business Name): MISTY MARIE SNYDER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GLENWOOD DR 201
WINTER PARK FL
32792-3315
US

IV. Provider business mailing address

2200 GLENWOOD DR 201
WINTER PARK FL
32792-3315
US

V. Phone/Fax

Practice location:
  • Phone: 407-740-5127
  • Fax: 407-740-0827
Mailing address:
  • Phone: 407-740-5127
  • Fax: 407-740-0827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9169351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: