Provider Demographics
NPI:1336130566
Name:SLOMIN, JAIME A (ARNP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:A
Last Name:SLOMIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S HARBOR CITY BLVD
Mailing Address - Street 2:STE 420
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5591
Mailing Address - Country:US
Mailing Address - Phone:321-541-1714
Mailing Address - Fax:321-676-9794
Practice Address - Street 1:2641 ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7185
Practice Address - Country:US
Practice Address - Phone:321-751-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9163438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9163438OtherLICENSE