MEDICARE: TERESA GAIL OLKOWSKI NP

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	363LG0600X	Gerontology Nurse Practitioner	ARNP2011042	FL

General Provider Information

NPI Number	:	1912904830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA GAIL OLKOWSKI NP

Provider Business Mailing Address
First Line	:	5866 BREAKWATER DR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3301
Country	:	US
Telephone Number	:	863-324-4549
Fax Number	:

Provider Business Practice Location Address
First Line	:	5866 BREAKWATER DR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3301
Country	:	US
Telephone Number	:	863-324-4549
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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