Provider Demographics
NPI:1831291152
Name:SLATTERY, VICKI DIANE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:DIANE
Last Name:SLATTERY
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:P. O. BOX 262
Mailing Address - Street 2:
Mailing Address - City:GRANDIN
Mailing Address - State:FL
Mailing Address - Zip Code:32138
Mailing Address - Country:US
Mailing Address - Phone:386-661-2744
Mailing Address - Fax:
Practice Address - Street 1:1601 SW ARCHER ROAD
Practice Address - Street 2:VA HOSPITAL, GERIATRIC CLINIC
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-379-4158
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1317232363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health