Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 803472 | FL |
NPI | 1013040682 |
---|---|
Provider Name | Octavia T Slevinski |
First Address | Pensacola, FL 32504-9029 |
Second Address | Pensacola, FL 32504-8721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |