Provider Demographics
NPI:1760778039
Name:SNELL, TIMOTHY EDMUND (ANP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EDMUND
Last Name:SNELL
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 WARDS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6969
Mailing Address - Country:US
Mailing Address - Phone:513-943-4000
Mailing Address - Fax:513-943-4240
Practice Address - Street 1:390 WARDS CORNER RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-6969
Practice Address - Country:US
Practice Address - Phone:513-943-4000
Practice Address - Fax:513-943-4240
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.296060-COA163WC0200X
OHCOA.12394-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH005052Medicaid
OHH005701Medicare PIN
OH005052Medicaid