Healthcare Provider Details

I. General information

NPI: 1508418062
Provider Name (Legal Business Name): TIFFANIE RENEE' SNYDER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804A HARPER RD
BECKLEY WV
25801-3331
US

IV. Provider business mailing address

1804A HARPER RD
BECKLEY WV
25801-3331
US

V. Phone/Fax

Practice location:
  • Phone: 304-250-6047
  • Fax: 304-250-6048
Mailing address:
  • Phone: 304-250-6047
  • Fax: 304-250-6048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number103936
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: