MEDICARE: EILEEN SNYDER NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3115522	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y6984	OTHER	FL	BLUE CROSS, BLUE SHIELD

General Provider Information

NPI Number	:	1588665632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN SNYDER NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	27080 LAMBETH RD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34602-7176
Country	:	US
Telephone Number	:	352-799-8798
Fax Number	:

Provider Business Practice Location Address
First Line	:	2653 N LECANTO HWY
Second Line	:
City	:	LECANTO
State	:	FL
Zip	:	34461-9679
Country	:	US
Telephone Number	:	352-527-9555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	01/27/2009

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