Basic Information
| Provider Information | |||||||||
| NPI: | 1205292653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLADEK | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | GOODWIN | ||||||||
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| Credential: | AGPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 CLINT MOORE RD # 227 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334872800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773455300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 902 CLINT MOORE RD # 227 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773455300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2016 | ||||||||
| LastUpdateDate: | 11/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN.0992151-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.