Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1756262 | FL |
NPI | 1023274727 |
---|---|
Provider Name | Ms. Kimberly Snyder Ristau |
First Address | Clearwater, FL 33760-2959 |
Second Address | St Petersburg, FL 33709-2106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 02/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BH638Z | MEDICARE NUMBER (01) | FL |