Provider Demographics
NPI:1083862262
Name:SLAICK, GERALDINE JUNE (CRNA)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:JUNE
Last Name:SLAICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 NW 132ND AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2969
Mailing Address - Country:US
Mailing Address - Phone:954-845-9667
Mailing Address - Fax:
Practice Address - Street 1:2901 W CYPRESS CREEK RD
Practice Address - Street 2:SUITE 111
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1730
Practice Address - Country:US
Practice Address - Phone:954-933-0377
Practice Address - Fax:954-933-0367
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-30
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3124012163W00000X
FL079012367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse