Healthcare Provider Details

I. General information

NPI: 1447175443
Provider Name (Legal Business Name): OLIVIA M NANTALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FAIRWAY DR STE 101
DEERFIELD BEACH FL
33441-1834
US

IV. Provider business mailing address

15511 TUCKERTON RD APT 519 APT 519
HOUSTON TX
77095-5299
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2878
  • Fax: 866-500-2186
Mailing address:
  • Phone: 520-635-9476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: