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General NPI Number Information
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NPI Number | 1588017388
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Entity Type | Individual
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Provider Name | KYLE SLAZYK PA-C, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 07/16/2016
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 3405 NW FEDERAL HWY
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City | JENSEN BEACH
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State | FL
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Zip | 34957-4403
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Country | US
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Telephone | 866-296-0942
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Fax |
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Provider Business Mailing Address
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Address Line | 2155 SW AUGUSTA TRCE
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City | PALM CITY
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State | FL
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Zip | 34990-4786
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Country | US
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Telephone | 954-261-6741
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL4162
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | PA9112925
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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