MEDICARE: LISA OLIVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW15869	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386217644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA OLIVER

Provider Business Mailing Address
First Line	:	7201 N 11TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7201 N 11TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5007
Country	:	US
Telephone Number	:	561-305-3813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	07/22/2021

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Directions to “ LISA OLIVER ” Practice Location

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