MEDICARE: GREGORY OLIVE

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	104100000X	Social Worker		FL

General Provider Information

NPI Number	:	1891141164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY OLIVE

Provider Business Mailing Address
First Line	:	390 N ORANGE AVE STE 2300
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-1684
Country	:	US
Telephone Number	:	877-646-3374
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 N ORANGE AVE
Second Line	:	STE 2300
City	:	ORLANDO
State	:	FL
Zip	:	32801-1640
Country	:	US
Telephone Number	:	877-646-3374
Fax Number	:

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

Provider Enumeration Date	:	05/05/2016
Last Update Date	:	05/05/2016

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Directions to “ GREGORY OLIVE ” Practice Location

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