Provider Demographics
NPI:1588229660
Name:SLOCUM, JEFFREY LEE JR (CRNP-BC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:SLOCUM
Suffix:JR
Gender:M
Credentials:CRNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 HAYCOCK RUN RD
Mailing Address - Street 2:
Mailing Address - City:KINTNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18930-9427
Mailing Address - Country:US
Mailing Address - Phone:215-704-5218
Mailing Address - Fax:
Practice Address - Street 1:680 BLAIR MILL RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2223
Practice Address - Country:US
Practice Address - Phone:215-589-8629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-05
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily