Provider Demographics
NPI:1538393749
Name:WALKER-SLATER, PAULETTE C
Entity type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:C
Last Name:WALKER-SLATER
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 1:10122 TIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-3349
Mailing Address - Country:US
Mailing Address - Phone:813-986-1011
Mailing Address - Fax:813-982-2039
Practice Address - Street 1:10122 TIMMONS RD
Practice Address - Street 2:
Practice Address - City:THONOTOSASSA
Practice Address - State:FL
Practice Address - Zip Code:33592-3349
Practice Address - Country:US
Practice Address - Phone:813-986-1011
Practice Address - Fax:813-982-2039
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906200311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000015100Medicaid