Provider Demographics
NPI:1659416402
Name:SNOOK, CRISTA (CRNA)
Entity Type:Individual
Prefix:
First Name:CRISTA
Middle Name:
Last Name:SNOOK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12230 W FOREST HILL BLVD
Mailing Address - Street 2:STE 182
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5700
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:706-434-8906
Practice Address - Street 1:12230 W FOREST HILL BLVD
Practice Address - Street 2:STE 182
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5700
Practice Address - Country:US
Practice Address - Phone:800-394-4445
Practice Address - Fax:706-434-8906
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLANT2684092367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered