Provider Demographics
NPI:1972083046
Name:SLIMAK, KRISTINE (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:SLIMAK
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 1:9822 SW 80TH WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7209
Mailing Address - Country:US
Mailing Address - Phone:352-284-9754
Mailing Address - Fax:
Practice Address - Street 1:1699 SW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1158
Practice Address - Country:US
Practice Address - Phone:352-627-5077
Practice Address - Fax:352-334-1521
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9219686363LP0222X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101096200Medicaid