Provider Demographics
NPI:1689019416
Name:SNAP 2 IT MEDICAL, PLLC
Entity Type:Organization
Organization Name:SNAP 2 IT MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHIZMAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:850-640-0014
Mailing Address - Street 1:2221 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2167
Mailing Address - Country:US
Mailing Address - Phone:850-640-0014
Mailing Address - Fax:850-640-0541
Practice Address - Street 1:2221 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2167
Practice Address - Country:US
Practice Address - Phone:850-640-0014
Practice Address - Fax:850-640-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1160941261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care