Provider Demographics
NPI:1649523143
Name:SLAYTON, HEATHER CATHERINE (PA)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:CATHERINE
Last Name:SLAYTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:CATHERINE
Other - Last Name:DELUCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-2030
Mailing Address - Fax:239-343-4116
Practice Address - Street 1:507 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2618
Practice Address - Country:US
Practice Address - Phone:239-772-0500
Practice Address - Fax:239-772-3076
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1951623826OtherMEDICARE PECOS ID
FLP01771721OtherRR MEDICARE
FLPA9106900OtherFL DOH PA LICENSE
FL019027900Medicaid
FL1649523143OtherNPI
FLI20141203001730OtherMEDICARE ENROLLMENT ID
FL363A00000XOtherMEDICARE TAXONOMY ID
FL4850001OtherAETNA
FLP978877OtherOPTIMUM
FL5QI08OtherBCBS
FL5023117OtherCIGNA
FLP1045436OtherFREEDOM
FL1107510OtherNCCPA
FL13887932OtherCAQH PROVIDER ID
FLHZ581YMedicare PIN