Provider Demographics
NPI:1194293720
Name:EDELSTEIN-SNIDER, TAMARA A (APRN)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:A
Last Name:EDELSTEIN-SNIDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7960 N WICKHAM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8096
Mailing Address - Country:US
Mailing Address - Phone:321-364-2822
Mailing Address - Fax:877-684-0805
Practice Address - Street 1:7960 N WICKHAM RD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8096
Practice Address - Country:US
Practice Address - Phone:321-364-2822
Practice Address - Fax:321-364-2844
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000057363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily