Provider Demographics
NPI:1548596083
Name:SLAVENS, CASANDRA L (ARNP)
Entity Type:Individual
Prefix:MS
First Name:CASANDRA
Middle Name:L
Last Name:SLAVENS
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 1:10973 SE 175TH PL # 100
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8983
Mailing Address - Country:US
Mailing Address - Phone:352-259-6553
Mailing Address - Fax:352-873-9397
Practice Address - Street 1:10973 SE 175TH PL # 100
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8983
Practice Address - Country:US
Practice Address - Phone:352-259-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9210033207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty