Provider Demographics
NPI:1609219856
Name:SNYDER, NICCOLE M (PA)
Entity Type:Individual
Prefix:
First Name:NICCOLE
Middle Name:M
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 LOFTIS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2981
Mailing Address - Country:US
Mailing Address - Phone:757-736-9860
Mailing Address - Fax:757-240-5537
Practice Address - Street 1:1031 LOFTIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2981
Practice Address - Country:US
Practice Address - Phone:757-736-9860
Practice Address - Fax:757-240-5537
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant