Provider Demographics
NPI:1164907820
Name:SLOTA, CASSANDRA (APRN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:SLOTA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:14601 HOPE CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4707
Mailing Address - Country:US
Mailing Address - Phone:239-334-7000
Mailing Address - Fax:239-334-7070
Practice Address - Street 1:14601 HOPE CENTER LOOP
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4707
Practice Address - Country:US
Practice Address - Phone:239-334-7000
Practice Address - Fax:239-334-7070
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9439941363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9439941OtherSTATE OF FLORIDA