Healthcare Provider Details

I. General information

NPI: 1053021717
Provider Name (Legal Business Name): MICHELLE L SNYDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 MEMORIAL CT
JACKSONVILLE NC
28546-6322
US

IV. Provider business mailing address

PO BOX 986513 DEPT 100
BOSTON MA
02298-6513
US

V. Phone/Fax

Practice location:
  • Phone: 910-346-3976
  • Fax: 910-353-0600
Mailing address:
  • Phone: 910-219-8326
  • Fax: 910-939-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5017314
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017314
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: