Provider Demographics
NPI:1104141928
Name:SLAUGHTER, CONNIE MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE
Last Name:SLAUGHTER
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 SEA LARK LN
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7472
Mailing Address - Country:US
Mailing Address - Phone:850-939-9721
Mailing Address - Fax:850-684-3066
Practice Address - Street 1:1772 SEA LARK LN
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7472
Practice Address - Country:US
Practice Address - Phone:850-939-9721
Practice Address - Fax:850-684-3066
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9459708363L00000X
KY3006421363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020978600Medicaid
FLYNZR7OtherBCBSFL
KYK174400Medicare PIN