Provider Demographics
NPI:1194297291
Name:ALONSO-SLUSARZ, JUDY ANN
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:ALONSO-SLUSARZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 KIRTS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4135
Mailing Address - Country:US
Mailing Address - Phone:248-434-6169
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:2600 LAKE LUCIEN DR STE 112
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7233
Practice Address - Country:US
Practice Address - Phone:321-207-9029
Practice Address - Fax:844-410-7960
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-30
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9172348207Q00000X
FLAPRN9172348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine