Healthcare Provider Details

I. General information

NPI: 1861558710
Provider Name (Legal Business Name): TAMARA R SNYDER C.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA R CROMLEY

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 S SAINT LOUIS AVE
TULSA OK
74120-5413
US

IV. Provider business mailing address

1124 S SAINT LOUIS AVE
TULSA OK
74120-5413
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0296
  • Fax: 918-592-0286
Mailing address:
  • Phone: 918-592-0286
  • Fax: 918-592-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN166419
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP 09148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: