Provider Demographics
NPI:1700685138
Name:SLOBODZIAN, HAILEY
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:SLOBODZIAN
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 1:1402 BEECHWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3467
Mailing Address - Country:US
Mailing Address - Phone:239-848-7787
Mailing Address - Fax:
Practice Address - Street 1:1402 BEECHWOOD TRL
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3467
Practice Address - Country:US
Practice Address - Phone:239-848-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11038074363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner