Healthcare Provider Details

I. General information

NPI: 1831291152
Provider Name (Legal Business Name): VICKI DIANE JASMIN-SLATTERY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 CENTRE ST
MELROSE FL
32666-6207
US

IV. Provider business mailing address

P. O. BOX 262
GRANDIN FL
32138
US

V. Phone/Fax

Practice location:
  • Phone: 352-475-3792
  • Fax: 352-475-3794
Mailing address:
  • Phone: 386-916-1791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1317232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: