Provider Demographics
NPI:1194127100
Name:SNEAD, GENA (NURSE)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:SNEAD
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-3850
Mailing Address - Country:US
Mailing Address - Phone:727-729-2981
Mailing Address - Fax:
Practice Address - Street 1:1625 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-3850
Practice Address - Country:US
Practice Address - Phone:727-729-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5181900374U00000X, 251E00000X, 251F00000X, 164W00000X, 376J00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No251F00000XAgenciesHome Infusion
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194127100OtherNPI