Provider Demographics
NPI:1033748157
Name:SNIDER, KATRINA LEA ANN
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LEA ANN
Last Name:SNIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 HOLLEY POINT RD
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-9508
Mailing Address - Country:US
Mailing Address - Phone:850-225-9984
Mailing Address - Fax:
Practice Address - Street 1:5041 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8916
Practice Address - Country:US
Practice Address - Phone:850-433-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006181363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid