Provider Demographics
NPI:1588665632
Name:SNYDER, EILEEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27080 LAMBETH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602-7176
Mailing Address - Country:US
Mailing Address - Phone:352-799-8798
Mailing Address - Fax:
Practice Address - Street 1:2653 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9679
Practice Address - Country:US
Practice Address - Phone:352-527-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3115522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3030857 00Medicaid
FLY6984OtherBLUE CROSS, BLUE SHIELD
FLR07218Medicare UPIN
FLY6984Medicare ID - Type Unspecified
FLY6984ZMedicare PIN