Provider Demographics
NPI:1871509810
Name:HELLER-SLEVIN, ROSALIND ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIND
Middle Name:ANN
Last Name:HELLER-SLEVIN
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 1:3762 N RIDE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7493
Mailing Address - Country:US
Mailing Address - Phone:904-262-6753
Mailing Address - Fax:
Practice Address - Street 1:12058 SAN JOSE BLVD
Practice Address - Street 2:SUITE1003
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8666
Practice Address - Country:US
Practice Address - Phone:904-880-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL735882363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303228100Medicaid
FLS58382Medicare UPIN
FL303228100Medicaid