Provider Demographics
NPI:1588017388
Name:SLAZYK, KYLE (PA-C, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SLAZYK
Suffix:
Gender:M
Credentials:PA-C, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 SW AUGUSTA TRCE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4786
Mailing Address - Country:US
Mailing Address - Phone:954-261-6741
Mailing Address - Fax:
Practice Address - Street 1:3405 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4403
Practice Address - Country:US
Practice Address - Phone:866-296-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-16
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL41622255A2300X
FLPA9112925261QU0200X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care